Individual
AWA SIDIBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 MAPLE AVE, STONY BROOK, NY 11790-1814
(646) 288-4981
Mailing address
830 FOX ST APT 8B, BRONX, NY 10459-5184
(646) 288-4981
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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