Provider Demographics
NPI:1982956256
Name:SOUMARE, NDEYE NDIAPPALY (STNA)
Entity Type:Individual
Prefix:
First Name:NDEYE
Middle Name:NDIAPPALY
Last Name:SOUMARE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 BROOKMILL CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-6707
Mailing Address - Country:US
Mailing Address - Phone:937-554-5985
Mailing Address - Fax:
Practice Address - Street 1:5214 BROOKMILL CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-6707
Practice Address - Country:US
Practice Address - Phone:937-554-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400678501007376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide