Provider Demographics
NPI:1093355216
Name:DAYNAB, BURHAN ADAM (ASSISTED LIVING)
Entity Type:Individual
Prefix:
First Name:BURHAN
Middle Name:ADAM
Last Name:DAYNAB
Suffix:
Gender:M
Credentials:ASSISTED LIVING
Other - Prefix:MR
Other - First Name:BURHAN
Other - Middle Name:ADAM
Other - Last Name:DAYNAB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1609 EDGEWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2101
Mailing Address - Country:US
Mailing Address - Phone:952-564-0682
Mailing Address - Fax:
Practice Address - Street 1:1609 EDGEWOOD AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-2101
Practice Address - Country:US
Practice Address - Phone:952-564-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health