Provider Demographics
NPI:1053376509
Name:SHOROYE, OLASENI ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:OLASENI
Middle Name:ALEXANDER
Last Name:SHOROYE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1859
Mailing Address - Country:US
Mailing Address - Phone:516-572-6131
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219348-1207R00000X, 208M00000X
VA0102201653207R00000X
CT038737207R00000X
CA13610208M00000X
NY219348208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014694Medicaid
VAP01198012OtherRR MEDICARE
VA1053376509Medicaid
VA010133734Medicaid
VAP01198012OtherRR MEDICARE
VA1053376509Medicaid
VAVV4562CMedicare PIN
H44844Medicare UPIN