Provider Demographics
NPI:1396104048
Name:SIDIBE, ABOULAYE (PA-C)
Entity type:Individual
Prefix:
First Name:ABOULAYE
Middle Name:
Last Name:SIDIBE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 PEARSALL DR
Mailing Address - Street 2:APT 1B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3946
Mailing Address - Country:US
Mailing Address - Phone:914-668-7432
Mailing Address - Fax:
Practice Address - Street 1:181 PEARSALL DR
Practice Address - Street 2:APT 1B
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3946
Practice Address - Country:US
Practice Address - Phone:914-668-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant