Provider Demographics
NPI:1043715535
Name:DIALLO, ABOU (NP)
Entity Type:Individual
Prefix:
First Name:ABOU
Middle Name:
Last Name:DIALLO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 139TH ST APT 12N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1518
Mailing Address - Country:US
Mailing Address - Phone:917-346-6296
Mailing Address - Fax:
Practice Address - Street 1:5445 ALMEDA RD STE 305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7447
Practice Address - Country:US
Practice Address - Phone:917-346-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342792363LF0000X
TX1029370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily