Provider Demographics
NPI:1679132732
Name:FARAH, AYAN ADAN
Entity Type:Individual
Prefix:
First Name:AYAN
Middle Name:ADAN
Last Name:FARAH
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 1:9333 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2320
Mailing Address - Country:US
Mailing Address - Phone:952-393-8233
Mailing Address - Fax:953-303-4837
Practice Address - Street 1:9333 PENN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2320
Practice Address - Country:US
Practice Address - Phone:952-393-8233
Practice Address - Fax:952-303-4837
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services