Provider Demographics
NPI:1114779535
Name:MOHAMED, ABDIASIS AHMED
Entity Type:Individual
Prefix:
First Name:ABDIASIS
Middle Name:AHMED
Last Name:MOHAMED
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 1:6685 MANRING CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5023
Mailing Address - Country:US
Mailing Address - Phone:614-966-3030
Mailing Address - Fax:
Practice Address - Street 1:6685 MANRING CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5023
Practice Address - Country:US
Practice Address - Phone:614-966-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide