Provider Demographics
NPI:1164295697
Name:MOHAMED, AYAN A
Entity Type:Individual
Prefix:
First Name:AYAN
Middle Name:A
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 1:1928 PORTLAND AVE # S302
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3469
Mailing Address - Country:US
Mailing Address - Phone:612-298-2894
Mailing Address - Fax:
Practice Address - Street 1:11005 OKINAWA ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6205
Practice Address - Country:US
Practice Address - Phone:612-298-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician