MEDICARE: HASSATOU DIALLO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1114560224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASSATOU DIALLO

Provider Business Mailing Address
First Line	:	3859 3RD AVE APT 806
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8250
Country	:	US
Telephone Number	:	917-306-9489
Fax Number	:

Provider Business Practice Location Address
First Line	:	3859 3RD AVE APT 806
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8250
Country	:	US
Telephone Number	:	917-306-9489
Fax Number	:

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

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	10/21/2019

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Directions to “ HASSATOU DIALLO ” Practice Location

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