Provider Demographics
NPI:1821676479
Name:DIACK, KHADY
Entity Type:Individual
Prefix:
First Name:KHADY
Middle Name:
Last Name:DIACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 PIPER PASS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3561
Mailing Address - Country:US
Mailing Address - Phone:713-540-6274
Mailing Address - Fax:
Practice Address - Street 1:4422 PIPER PASS LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3561
Practice Address - Country:US
Practice Address - Phone:713-540-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program