Provider Demographics
NPI:1720153471
Name:SACKEY, JOYCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:A
Last Name:SACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:A
Other - Last Name:SACKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:136 HARRISON AVE
Mailing Address - Street 2:SACKLER 8TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1817
Mailing Address - Country:US
Mailing Address - Phone:617-636-6565
Mailing Address - Fax:
Practice Address - Street 1:136 HARRISON AVE
Practice Address - Street 2:SACKLER 8TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1817
Practice Address - Country:US
Practice Address - Phone:617-636-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3070191Medicaid
MA3070191Medicaid
MAJ10488Medicare ID - Type Unspecified