Provider Demographics
NPI:1437802311
Name:ABDULRAHMAN, SUMEYA HAMZA I
Entity Type:Individual
Prefix:MISS
First Name:SUMEYA
Middle Name:HAMZA
Last Name:ABDULRAHMAN
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 1:618 9TH AVE S APT 409
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-4611
Mailing Address - Country:US
Mailing Address - Phone:763-528-5609
Mailing Address - Fax:
Practice Address - Street 1:618 9TH AVE S APT 409
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-5541
Practice Address - Country:US
Practice Address - Phone:763-528-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNJ650172588111103TC2200X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4565500255Medicaid