Healthcare Provider Details

I. General information

NPI: 1922594746
Provider Name (Legal Business Name): MAMADOU SALIOU DIALLO DNP, FNP-BC,PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 08/21/2023
Certification Date: 08/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CLINT DR STE 200
PICKERINGTON OH
43147-7794
US

IV. Provider business mailing address

161 CLINT DR STE 200
PICKERINGTON OH
43147-7794
US

V. Phone/Fax

Practice location:
  • Phone: 614-705-6161
  • Fax: 614-705-6151
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number023055
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP023055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: