Provider Demographics
NPI:1073385332
Name:ABDULLE, FAID MOHAMED
Entity Type:Individual
Prefix:
First Name:FAID
Middle Name:MOHAMED
Last Name:ABDULLE
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 1:432 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2559
Mailing Address - Country:US
Mailing Address - Phone:612-707-2279
Mailing Address - Fax:
Practice Address - Street 1:432 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2559
Practice Address - Country:US
Practice Address - Phone:612-707-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician