Provider Demographics
NPI:1629834874
Name:SHAHIN, MADINA ALI
Entity type:Individual
Prefix:
First Name:MADINA
Middle Name:ALI
Last Name:SHAHIN
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 1:4201 DEAN LAKES BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2863
Mailing Address - Country:US
Mailing Address - Phone:612-509-6681
Mailing Address - Fax:
Practice Address - Street 1:9065 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3502
Practice Address - Country:US
Practice Address - Phone:952-452-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician