Healthcare Provider Details

I. General information

NPI: 1881800738
Provider Name (Legal Business Name): COREYANN K POLY GERACIE PHD, RDN, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 QUAKER HWY
UXBRIDGE MA
01569-1628
US

IV. Provider business mailing address

130 ELMSHADE DR
UXBRIDGE MA
01569-2601
US

V. Phone/Fax

Practice location:
  • Phone: 508-278-7810
  • Fax:
Mailing address:
  • Phone: 508-278-9713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number32
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: