Provider Demographics
NPI:1811782261
Name:SALAH, FARTUN SHOKE
Entity type:Individual
Prefix:
First Name:FARTUN
Middle Name:SHOKE
Last Name:SALAH
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 1:1990 BURNS AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4971
Mailing Address - Country:US
Mailing Address - Phone:612-481-6172
Mailing Address - Fax:612-444-8834
Practice Address - Street 1:1990 BURNS AVE APT 107
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4971
Practice Address - Country:US
Practice Address - Phone:612-481-6172
Practice Address - Fax:612-444-8834
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician