Provider Demographics
NPI:1205383742
Name:GELLE, FARHIYA MAHAMUD I
Entity Type:Individual
Prefix:
First Name:FARHIYA
Middle Name:MAHAMUD
Last Name:GELLE
Suffix:I
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 1:6329 5TH ST NE APT 8
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5029
Mailing Address - Country:US
Mailing Address - Phone:763-447-5303
Mailing Address - Fax:
Practice Address - Street 1:6329 5TH STREET NE APT 8
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-447-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN896496600024332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies