Provider Demographics
NPI:1386231751
Name:DIEYE-LANDER, AWA (STUDENT)
Entity Type:Individual
Prefix:
First Name:AWA
Middle Name:
Last Name:DIEYE-LANDER
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-0607
Mailing Address - Country:US
Mailing Address - Phone:302-377-6494
Mailing Address - Fax:
Practice Address - Street 1:32 BEAMAN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MA
Practice Address - Zip Code:01541-1113
Practice Address - Country:US
Practice Address - Phone:302-377-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program