=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497478994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE HAY PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2022
-----------------------------------------------------
Last Update Date | 11/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 LINDEN OAKS STE 300
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14625-2839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-383-4420
-----------------------------------------------------
Fax | 585-383-4515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 295 HENDRIX RD
-----------------------------------------------------
City | WEST HENRIETTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14586-8823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-794-6824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 029162
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 029162
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------