Provider Demographics
NPI:1780259952
Name:ALI, FADUMO MOHAMED
Entity type:Individual
Prefix:
First Name:FADUMO
Middle Name:MOHAMED
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AYAN
Other - Middle Name:MOHAMED
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12713 WELCOME LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3621
Mailing Address - Country:US
Mailing Address - Phone:612-876-1163
Mailing Address - Fax:
Practice Address - Street 1:12713 WELCOME LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3621
Practice Address - Country:US
Practice Address - Phone:612-876-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician