Provider Demographics
NPI:1285478305
Name:JAMA, SAHRA ABDIRAHMAN
Entity type:Individual
Prefix:
First Name:SAHRA
Middle Name:ABDIRAHMAN
Last Name:JAMA
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 1:4310 N WOODGATE LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2277
Mailing Address - Country:US
Mailing Address - Phone:651-402-8028
Mailing Address - Fax:
Practice Address - Street 1:4310 N WOODGATE LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2277
Practice Address - Country:US
Practice Address - Phone:651-402-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNG000067864800106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician