Provider Demographics
NPI:1144709064
Name:FRASIER, DOMINIQUE D (MSED)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:D
Last Name:FRASIER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 TOPSFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8679
Mailing Address - Country:US
Mailing Address - Phone:646-286-5960
Mailing Address - Fax:
Practice Address - Street 1:5962 ROUTE 31
Practice Address - Street 2:SUITE 7
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-698-0033
Practice Address - Fax:315-698-0031
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency