Provider Demographics
NPI:1629516711
Name:NDIAYE, AWA
Entity Type:Individual
Prefix:MRS
First Name:AWA
Middle Name:
Last Name:NDIAYE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AWA
Other - Middle Name:
Other - Last Name:NDIAYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:7491 MAHAFFEY DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9538
Mailing Address - Country:US
Mailing Address - Phone:614-260-8868
Mailing Address - Fax:
Practice Address - Street 1:7491 MAHAFFEY DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9538
Practice Address - Country:US
Practice Address - Phone:614-260-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.413023163W00000X
OHAPRN.CNP.0027221363LF0000X
KY3017326363LF0000X
TX1071378363LF0000X, 363LP0808X
OH2023124944363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily