Provider Demographics
NPI:1750568069
Name:ROY, MICHELE PAULA (LICAC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:PAULA
Last Name:ROY
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1742
Mailing Address - Country:US
Mailing Address - Phone:508-363-3490
Mailing Address - Fax:508-798-3418
Practice Address - Street 1:82 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1742
Practice Address - Country:US
Practice Address - Phone:508-363-3490
Practice Address - Fax:508-798-3418
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist