Provider Demographics
NPI:1992478242
Name:DUALE, FAYRUS ABDIRAHMAN
Entity type:Individual
Prefix:
First Name:FAYRUS
Middle Name:ABDIRAHMAN
Last Name:DUALE
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 1:1901 W 80 1/2 ST UNIT 429
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-5108
Mailing Address - Country:US
Mailing Address - Phone:614-805-1982
Mailing Address - Fax:
Practice Address - Street 1:1901 W 80 1/2 ST UNIT 429
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-5108
Practice Address - Country:US
Practice Address - Phone:614-805-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst