Provider Demographics
NPI:1548844046
Name:SIDIBE, BADIALLO (RN)
Entity type:Individual
Prefix:
First Name:BADIALLO
Middle Name:
Last Name:SIDIBE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JOHNNY CAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5674
Mailing Address - Country:US
Mailing Address - Phone:401-846-1213
Mailing Address - Fax:401-848-6398
Practice Address - Street 1:191 SOCIAL ST STE 180
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3213
Practice Address - Country:US
Practice Address - Phone:401-356-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN63526163W00000X
RIAPRN04082363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse