Healthcare Provider Details

I. General information

NPI: 1275253296
Provider Name (Legal Business Name): MAKAYLA BROOKE HAYES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 07/22/2023
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

7 NELSON ST
ROCHESTER NY
14620-1521
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number28772
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number028772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: