Provider Demographics
NPI:1417508540
Name:SIDIBAY, ASSANATU FANTA
Entity Type:Individual
Prefix:MRS
First Name:ASSANATU
Middle Name:FANTA
Last Name:SIDIBAY
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 1:5642 ISAAC RD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8330
Mailing Address - Country:US
Mailing Address - Phone:614-735-0182
Mailing Address - Fax:
Practice Address - Street 1:5642 ISAAC RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8330
Practice Address - Country:US
Practice Address - Phone:614-735-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider