Provider Demographics
NPI:1851182646
Name:ALI, SAMIRA ABDISAMED
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:ABDISAMED
Last Name:ALI
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 1:5100 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3000
Mailing Address - Country:US
Mailing Address - Phone:612-220-1840
Mailing Address - Fax:
Practice Address - Street 1:5100 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3000
Practice Address - Country:US
Practice Address - Phone:612-220-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician