Healthcare Provider Details

I. General information

NPI: 1356713945
Provider Name (Legal Business Name): ALEXANDRIA S RIVAZFAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 SCIENCE PKWY
ROCHESTER NY
14620-4251
US

IV. Provider business mailing address

259 MONROE AVE STE 100
ROCHESTER NY
14607-3632
US

V. Phone/Fax

Practice location:
  • Phone: 585-545-7200
  • Fax: 585-244-8177
Mailing address:
  • Phone: 585-545-7200
  • Fax: 585-244-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number019196
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8156
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: