Provider Demographics
NPI:1821867045
Name:MOHAMED, ASHA SHAFI
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:SHAFI
Last Name:MOHAMED
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 1:1054 8TH AVE S APT 8
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-3119
Mailing Address - Country:US
Mailing Address - Phone:207-344-4975
Mailing Address - Fax:
Practice Address - Street 1:9358 ENSIGN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1472
Practice Address - Country:US
Practice Address - Phone:612-213-6729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst