Provider Demographics
NPI:1922594746
Name:DIALLO, MAMADOU SALIOU (DNP, FNP-BC,PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MAMADOU
Middle Name:SALIOU
Last Name:DIALLO
Suffix:
Gender:M
Credentials:DNP, FNP-BC,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CLINT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 CLINT DR STE 200
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7794
Practice Address - Country:US
Practice Address - Phone:614-705-6161
Practice Address - Fax:614-705-6151
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP023055363LP0808X
OH023055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health