Healthcare Provider Details

I. General information

NPI: 1982209987
Provider Name (Legal Business Name): FELICITE SIBAILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 STAFFORD ST
WORCESTER MA
01603-1440
US

IV. Provider business mailing address

600 MAIN ST APT 2407
WORCESTER MA
01608-2067
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3297
  • Fax:
Mailing address:
  • Phone: 774-232-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH27748
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: