Provider Demographics
NPI:1376295899
Name:MOHAMUD, SHARMARKE
Entity Type:Individual
Prefix:
First Name:SHARMARKE
Middle Name:
Last Name:MOHAMUD
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 1:12708 WAYZATA BLVD APT 412
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1958
Mailing Address - Country:US
Mailing Address - Phone:612-404-8041
Mailing Address - Fax:
Practice Address - Street 1:12708 WAYZATA BLVD APT 412
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-1958
Practice Address - Country:US
Practice Address - Phone:612-404-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant