Provider Demographics
NPI:1922872563
Name:AHMED, MOHAMED SHEIKH
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:SHEIKH
Last Name:AHMED
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 1:2919 W 2730 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1809
Mailing Address - Country:US
Mailing Address - Phone:801-750-3116
Mailing Address - Fax:
Practice Address - Street 1:2919 W 2730 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1809
Practice Address - Country:US
Practice Address - Phone:801-750-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
UT172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver