Healthcare Provider Details

I. General information

NPI: 1598294704
Provider Name (Legal Business Name): AYAD SADDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE STE 287
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

1425 PORTLAND AVE # 287
ROCHESTER NY
14621-3011
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number305612
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP04122
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number305612
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number305612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: