Provider Demographics
NPI:1790913564
Name:DIALLO, AYE DIOULDE (PA)
Entity Type:Individual
Prefix:
First Name:AYE
Middle Name:DIOULDE
Last Name:DIALLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AYE
Other - Middle Name:DIALLO
Other - Last Name:SOUSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:US DEPT OFSTATE
Mailing Address - Street 2:2401 E STREET
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0001
Mailing Address - Country:US
Mailing Address - Phone:202-663-2453
Mailing Address - Fax:202-663-3247
Practice Address - Street 1:US DEPT OFSTATE
Practice Address - Street 2:2401 E STREET
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0001
Practice Address - Country:US
Practice Address - Phone:202-663-2453
Practice Address - Fax:202-663-3247
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant