Provider Demographics
NPI:1861932824
Name:PARADISO-CLARK, DOMINI MICHELINA (PA)
Entity type:Individual
Prefix:
First Name:DOMINI
Middle Name:MICHELINA
Last Name:PARADISO-CLARK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DOMINI
Other - Middle Name:MICHELINA
Other - Last Name:PARADISO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3363 TREMONT RD STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2127
Practice Address - Country:US
Practice Address - Phone:614-788-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH99999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant