Provider Demographics
NPI:1376301267
Name:FORD, SADIE VELEKA
Entity Type:Individual
Prefix:MS
First Name:SADIE
Middle Name:VELEKA
Last Name:FORD
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 1:2112 BROADWAY ST NE STE 225
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-3081
Mailing Address - Country:US
Mailing Address - Phone:763-219-9107
Mailing Address - Fax:
Practice Address - Street 1:13588 NAGELL CIR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-3318
Practice Address - Country:US
Practice Address - Phone:176-321-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6NBMUB1WME335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier