Provider Demographics
NPI:1922476001
Name:DIABO, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DIABO
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 1:41 TYLER TRL
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1322
Mailing Address - Country:US
Mailing Address - Phone:585-753-5263
Mailing Address - Fax:585-324-4331
Practice Address - Street 1:691 SAINT PAUL ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1706
Practice Address - Country:US
Practice Address - Phone:585-753-5263
Practice Address - Fax:585-324-4331
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator