Provider Demographics
NPI:1861290207
Name:ABDULLAHI, KHALID MOHAMED
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:MOHAMED
Last Name:ABDULLAHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 SUNCREST DR APT 310
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-0015
Mailing Address - Country:US
Mailing Address - Phone:612-806-6333
Mailing Address - Fax:
Practice Address - Street 1:1160 SUNCREST DR APT 310
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-0015
Practice Address - Country:US
Practice Address - Phone:612-806-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician