Provider Demographics
NPI:1699475202
Name:HASSAN, SHAMSUDIN
Entity type:Individual
Prefix:
First Name:SHAMSUDIN
Middle Name:
Last Name:HASSAN
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 1:2625 E FRANKLIN AVE STE LL4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1195
Mailing Address - Country:US
Mailing Address - Phone:763-213-3551
Mailing Address - Fax:
Practice Address - Street 1:2625 E FRANKLIN AVE STE LL4
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1195
Practice Address - Country:US
Practice Address - Phone:763-213-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health