Individual
MR. AMIDOU DIARRASSOUBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6271 FLEETWOOD CT APT 2, FORT RILEY, KS 66442-3333
(646) 730-2841
Mailing address
1265 WALTON AVE APT 4BS, BRONX, NY 10452-7807
(646) 730-2841
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251E00000X
Home Health Agency
—
—
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/07/2019
Last updated
08/26/2025
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