Provider Demographics
NPI:1114608031
Name:MOHAMED, FADUMA ABDIRIZAK
Entity Type:Individual
Prefix:
First Name:FADUMA
Middle Name:ABDIRIZAK
Last Name:MOHAMED
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 1:1410 ENERGY PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5266
Mailing Address - Country:US
Mailing Address - Phone:161-266-6880
Mailing Address - Fax:
Practice Address - Street 1:1410 ENERGY PARK DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5266
Practice Address - Country:US
Practice Address - Phone:161-266-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst