Provider Demographics
NPI:1366849531
Name:DIALLO, AISSATOU (LPN)
Entity Type:Individual
Prefix:
First Name:AISSATOU
Middle Name:
Last Name:DIALLO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 FRANKLIN AVE
Mailing Address - Street 2:APT#11
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6936
Mailing Address - Country:US
Mailing Address - Phone:347-488-0445
Mailing Address - Fax:
Practice Address - Street 1:1090 FRANKLIN AVE
Practice Address - Street 2:APT 11C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:347-488-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse