Provider Demographics
NPI:1427715622
Name:DIALLO, IBRAHIMA SORY
Entity type:Individual
Prefix:
First Name:IBRAHIMA
Middle Name:SORY
Last Name:DIALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 STONECREEK DR S STE 103
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9869
Mailing Address - Country:US
Mailing Address - Phone:614-965-6760
Mailing Address - Fax:
Practice Address - Street 1:1505 STONECREEK DR S STE 103
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9869
Practice Address - Country:US
Practice Address - Phone:614-965-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care