MEDICARE: LYDIA JALLAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	551950	OH

General Provider Information

NPI Number	:	1467386698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA JALLAH

Provider Business Mailing Address
First Line	:	6723 DOROTHYS XING
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-7903
Country	:	US
Telephone Number	:	614-974-9250
Fax Number	:

Provider Business Practice Location Address
First Line	:	6723 DOROTHYS XING
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-7903
Country	:	US
Telephone Number	:	614-974-9250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ LYDIA JALLAH ” Practice Location

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