Provider Demographics
NPI:1891323408
Name:AHMED, SADA
Entity type:Individual
Prefix:
First Name:SADA
Middle Name:
Last Name:AHMED
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 1:7362 UNIVERSITY AVE NE STE 311
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3150
Mailing Address - Country:US
Mailing Address - Phone:612-986-0643
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3727
Practice Address - Country:US
Practice Address - Phone:651-232-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2024-03-07
Deactivation Date:2020-03-31
Deactivation Code:
Reactivation Date:2024-01-08
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
MN11319363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No253Z00000XAgenciesIn Home Supportive Care