MEDICARE: MOMODOU BAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	408374	NY

General Provider Information

NPI Number	:	1053255539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOMODOU BAH

Provider Business Mailing Address
First Line	:	5601 NY-31
Second Line	:	PO BOX 206
City	:	CLAY
State	:	NY
Zip	:	13041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SIMS DR
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13244-4412
Country	:	US
Telephone Number	:	315-288-6898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	06/02/2026

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Directions to “ MOMODOU BAH ” Practice Location

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