Provider Demographics
NPI:1114560224
Name:DIALLO, HASSATOU
Entity Type:Individual
Prefix:
First Name:HASSATOU
Middle Name:
Last Name:DIALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 3RD AVE APT 806
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8250
Mailing Address - Country:US
Mailing Address - Phone:917-306-9489
Mailing Address - Fax:
Practice Address - Street 1:3859 3RD AVE APT 806
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8250
Practice Address - Country:US
Practice Address - Phone:917-306-9489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program