Healthcare Provider Details

I. General information

NPI: 1548844046
Provider Name (Legal Business Name): BADIALLO SIDIBE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST BLDG C
DANVERS MA
01923-2763
US

IV. Provider business mailing address

75 SYLVAN ST BLDG C
DANVERS MA
01923-2763
US

V. Phone/Fax

Practice location:
  • Phone: 978-212-1010
  • Fax: 978-961-6339
Mailing address:
  • Phone: 888-769-5201
  • Fax: 978-961-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN63526
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN04082
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: