Healthcare Provider Details

I. General information

NPI: 1639036478
Provider Name (Legal Business Name): TYANA DILUZ JACOBS-ALOYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LINCOLN SQ
WORCESTER MA
01608-1135
US

IV. Provider business mailing address

60 SALISBURY ST UNIT 308
WORCESTER MA
01609-3133
US

V. Phone/Fax

Practice location:
  • Phone: 508-890-8855
  • Fax:
Mailing address:
  • Phone: 413-242-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: