Healthcare Provider Details

I. General information

NPI: 1366369720
Provider Name (Legal Business Name): DJELL FABRICE LOEMBA NDELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 ASHTEAD DR
NEW ALBANY OH
43054-8773
US

IV. Provider business mailing address

6160 ASHTEAD DR
NEW ALBANY OH
43054-8773
US

V. Phone/Fax

Practice location:
  • Phone: 267-506-4743
  • Fax:
Mailing address:
  • Phone: 267-506-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: