Provider Demographics
NPI:1184131211
Name:DIALLO, HALIMA SADIA
Entity type:Individual
Prefix:
First Name:HALIMA
Middle Name:SADIA
Last Name:DIALLO
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 1:74 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1200
Mailing Address - Country:US
Mailing Address - Phone:617-733-5916
Mailing Address - Fax:
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-420-0048
Practice Address - Fax:617-442-0135
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN285291163WH0200X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WH0200XNursing Service ProvidersRegistered NurseHome Health