Healthcare Provider Details

I. General information

NPI: 1639866254
Provider Name (Legal Business Name): SANDRA TOLULOPE AWELE ALEX-OJEI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date: 11/27/2023
Reactivation Date: 12/11/2023

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-5067
  • Fax: 585-922-2908
Mailing address:
  • Phone:
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number346574
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number346574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: