Provider Demographics
NPI:1689435547
Name:NDIAYE, AMADOU
Entity Type:Individual
Prefix:
First Name:AMADOU
Middle Name:
Last Name:NDIAYE
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 1:22851 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1990
Mailing Address - Country:US
Mailing Address - Phone:586-218-8570
Mailing Address - Fax:
Practice Address - Street 1:22851 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1990
Practice Address - Country:US
Practice Address - Phone:586-218-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty