Provider Demographics
NPI:1487547865
Name:SIAD, ABDI NASSIR MOHAMED
Entity type:Individual
Prefix:
First Name:ABDI NASSIR
Middle Name:MOHAMED
Last Name:SIAD
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 1:2515 S 9TH ST APT 702
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1034
Mailing Address - Country:US
Mailing Address - Phone:612-978-1273
Mailing Address - Fax:
Practice Address - Street 1:2515 S 9TH ST APT 702
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1034
Practice Address - Country:US
Practice Address - Phone:612-978-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician