Provider Demographics
NPI:1508681933
Name:SIDI, FATIMATOU
Entity type:Individual
Prefix:
First Name:FATIMATOU
Middle Name:
Last Name:SIDI
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 1:1670 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7106
Mailing Address - Country:US
Mailing Address - Phone:716-604-3221
Mailing Address - Fax:
Practice Address - Street 1:1670 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7106
Practice Address - Country:US
Practice Address - Phone:716-604-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula