Individual
STACY M POULIOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510
(203) 688-4242
(203) 737-5187
Mailing address
49 SHERMAN LN, HAMDEN, CT 06514
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00622000
NJ
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
4135
CT
Other
Enumeration date
05/26/2018
Last updated
09/22/2021
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