Provider Demographics
NPI:1609568906
Name:BARRY, AMADOU
Entity Type:Individual
Prefix:
First Name:AMADOU
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 TEALWATER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-7489
Mailing Address - Country:US
Mailing Address - Phone:773-600-5520
Mailing Address - Fax:
Practice Address - Street 1:2609 TEALWATER TRAIL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-7489
Practice Address - Country:US
Practice Address - Phone:773-600-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide