Provider Demographics
NPI:1215526389
Name:MAHAMUD, SUAD
Entity type:Individual
Prefix:
First Name:SUAD
Middle Name:
Last Name:MAHAMUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 14TH AVE NE APT 102
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-5103
Mailing Address - Country:US
Mailing Address - Phone:614-747-1266
Mailing Address - Fax:
Practice Address - Street 1:900 14TH AVE NE APT 102
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-5103
Practice Address - Country:US
Practice Address - Phone:614-747-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician