Provider Demographics
NPI:1760254254
Name:ABDI, SAGAL A
Entity Type:Individual
Prefix:
First Name:SAGAL
Middle Name:A
Last Name:ABDI
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 1:2025 28TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-5366
Mailing Address - Country:US
Mailing Address - Phone:612-836-7788
Mailing Address - Fax:
Practice Address - Street 1:2025 28TH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5366
Practice Address - Country:US
Practice Address - Phone:612-836-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician