Provider Demographics
NPI:1548603442
Name:JALLOH, AMADU WURIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:AMADU
Middle Name:WURIE
Last Name:JALLOH
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 CRITTENDEN WAY # 6
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-208-3637
Mailing Address - Fax:
Practice Address - Street 1:268 CRITTENDEN WAY APT 6
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2219
Practice Address - Country:US
Practice Address - Phone:585-208-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614216-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse