Provider Demographics
NPI:1396008637
Name:POYAU, MARIE IMMACULA SHERLEY
Entity Type:Individual
Prefix:
First Name:MARIE IMMACULA
Middle Name:SHERLEY
Last Name:POYAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:MARIE IMMACULA
Other - Last Name:POYAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1059
Mailing Address - Country:US
Mailing Address - Phone:508-368-4000
Mailing Address - Fax:
Practice Address - Street 1:309 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-368-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program