Provider Demographics
NPI:1538763644
Name:MAHAMUD, ZAHRA ABDI
Entity type:Individual
Prefix:
First Name:ZAHRA
Middle Name:ABDI
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 1:2825 PASCAL ST APT 23F
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7106
Mailing Address - Country:US
Mailing Address - Phone:952-457-4203
Mailing Address - Fax:
Practice Address - Street 1:2825 PASCAL ST APT 23F
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-7106
Practice Address - Country:US
Practice Address - Phone:952-457-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician