Provider Demographics
NPI:1508800285
Name:BROBBY, SOUAD N (PA)
Entity Type:Individual
Prefix:
First Name:SOUAD
Middle Name:N
Last Name:BROBBY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SOUAD
Other - Middle Name:
Other - Last Name:NASHIEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:6350 W 143RD ST STE 200
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2890
Practice Address - Country:US
Practice Address - Phone:952-428-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04869363A00000X
MN11041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X6086OtherBCBS
TX8K9101Medicare PIN
TX8X6086OtherBCBS
TX8L7163Medicare PIN