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NPI Code Detail

MEDICARE: DJENEBA SACKO

MEDICARE: DJENEBA SACKO
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1134058894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DJENEBA SACKO
Provider Business Mailing Address
First Line : 5444 WICHITA DR APT D8
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-3141
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5444 WICHITA DR APT D8
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-3141
Country : US
Telephone Number : 469-592-0533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2026
Last Update Date : 05/18/2026

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Directions to “ DJENEBA SACKO ” Practice Location

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