Healthcare Provider Details

I. General information

NPI: 1013523968
Provider Name (Legal Business Name): VICTORIA SEKOU-MAMADOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 PALMER RD SW
ETNA OH
43062-9024
US

IV. Provider business mailing address

6096 E MAIN ST STE 109
COLUMBUS OH
43213-4302
US

V. Phone/Fax

Practice location:
  • Phone: 161-484-3429
  • Fax:
Mailing address:
  • Phone: 614-843-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number2548103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: