Provider Demographics
NPI:1730327354
Name:SELLATI, LACEY MARIE (RN, LICAC, PA-C)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:MARIE
Last Name:SELLATI
Suffix:
Gender:F
Credentials:RN, LICAC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5632
Mailing Address - Country:US
Mailing Address - Phone:781-424-0974
Mailing Address - Fax:
Practice Address - Street 1:626 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-3302
Practice Address - Country:US
Practice Address - Phone:978-610-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239503202D00000X, 171100000X
MAPA5404202D00000X, 363A00000X
MA269439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse