Provider Demographics
NPI:1083130405
Name:ABDI, AYAN ABDULLAHI
Entity Type:Individual
Prefix:
First Name:AYAN
Middle Name:ABDULLAHI
Last Name:ABDI
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 1:3931 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-2434
Mailing Address - Country:US
Mailing Address - Phone:614-432-7807
Mailing Address - Fax:614-432-7894
Practice Address - Street 1:3931 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-2434
Practice Address - Country:US
Practice Address - Phone:614-432-7807
Practice Address - Fax:614-432-7894
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSZ539375343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0203763Medicaid