Provider Demographics
NPI:1326873373
Name:AHMED, ABDILLAHI
Entity type:Individual
Prefix:
First Name:ABDILLAHI
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 89TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434
Mailing Address - Country:US
Mailing Address - Phone:703-389-7174
Mailing Address - Fax:
Practice Address - Street 1:641 89TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2302
Practice Address - Country:US
Practice Address - Phone:763-306-3435
Practice Address - Fax:763-306-3435
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2025-02-04
Deactivation Date:2025-01-11
Deactivation Code:
Reactivation Date:2025-02-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty