MEDICARE: MAMADOU 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1558293688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMADOU DIALLO

Provider Business Mailing Address
First Line	:	4529 SQUIREDALE SQ
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-1233
Country	:	US
Telephone Number	:	202-876-4236
Fax Number	:

Provider Business Practice Location Address
First Line	:	4529 SQUIREDALE SQ
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-1233
Country	:	US
Telephone Number	:	202-876-4236
Fax Number	:

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

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

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Directions to “ MAMADOU DIALLO ” Practice Location

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