Provider Demographics
NPI:1942076971
Name:YUSUF, SUHAIB
Entity Type:Individual
Prefix:
First Name:SUHAIB
Middle Name:
Last Name:YUSUF
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 1:1821 UNIVERSITY AVE W STE 223
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2801
Mailing Address - Country:US
Mailing Address - Phone:161-235-7194
Mailing Address - Fax:
Practice Address - Street 1:5701 KENTUCKY AVE N STE 201
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3394
Practice Address - Country:US
Practice Address - Phone:612-386-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician