Provider Demographics
NPI:1114325701
Name:OUEDRAOGO TALL, SAKINA (MD)
Entity Type:Individual
Prefix:
First Name:SAKINA
Middle Name:
Last Name:OUEDRAOGO TALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAKINA
Other - Middle Name:
Other - Last Name:OUEDRAOGO TALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8268 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-4343
Practice Address - Fax:718-883-6330
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282076207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine