Provider Demographics
NPI:1780449264
Name:ABDULAHI, SUHAIB
Entity type:Individual
Prefix:
First Name:SUHAIB
Middle Name:
Last Name:ABDULAHI
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 1:12935 299TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-3637
Mailing Address - Country:US
Mailing Address - Phone:612-229-9447
Mailing Address - Fax:
Practice Address - Street 1:6260 HIGHWAY 65 NE # 303
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5150
Practice Address - Country:US
Practice Address - Phone:612-229-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician