Healthcare Provider Details

I. General information

NPI: 1245157528
Provider Name (Legal Business Name): AYUBU ALOYCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 SEABROOK ST
ROCHESTER NY
14621-4616
US

IV. Provider business mailing address

76 SEABROOK ST
ROCHESTER NY
14621-4616
US

V. Phone/Fax

Practice location:
  • Phone: 585-664-6290
  • Fax:
Mailing address:
  • Phone: 585-664-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number035818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: