Provider Demographics
NPI:1316455546
Name:SHATO, SAADA OUMER
Entity type:Individual
Prefix:
First Name:SAADA
Middle Name:OUMER
Last Name:SHATO
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 1:12161 GROUSE ST NW APT 302
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1995
Mailing Address - Country:US
Mailing Address - Phone:612-481-2995
Mailing Address - Fax:612-256-8430
Practice Address - Street 1:12161 GROUSE ST NW APT 302
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-1995
Practice Address - Country:US
Practice Address - Phone:612-481-2995
Practice Address - Fax:612-256-8430
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty