Healthcare Provider Details

I. General information

NPI: 1336993351
Provider Name (Legal Business Name): AISSATA DIALLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S COLLINS RD STE 300
SUNNYVALE TX
75182-4642
US

IV. Provider business mailing address

1585 NEIL AVE
COLUMBUS OH
43210-1216
US

V. Phone/Fax

Practice location:
  • Phone: 469-864-7586
  • Fax:
Mailing address:
  • Phone: 614-292-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1189749
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1189749
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.519350
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: