Provider Demographics
NPI:1104613074
Name:EREG, SAHRA
Entity type:Individual
Prefix:
First Name:SAHRA
Middle Name:
Last Name:EREG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 146TH ST STE 119
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4655
Mailing Address - Country:US
Mailing Address - Phone:773-691-7724
Mailing Address - Fax:
Practice Address - Street 1:1000 E 146TH ST STE 119
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4655
Practice Address - Country:US
Practice Address - Phone:773-691-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician