Provider Demographics
NPI:1386937472
Name:SANNITI, DOMINIC V (DO)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:V
Last Name:SANNITI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-632-0408
Mailing Address - Fax:440-632-0601
Practice Address - Street 1:15976 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9474
Practice Address - Country:US
Practice Address - Phone:440-632-0408
Practice Address - Fax:440-632-0601
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
OH34-011233207Q00000X
GA68553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129891AMedicaid
GA202I085045Medicare PIN