Provider Demographics
NPI:1801611215
Name:DAWUD, SHENGO KIBRI
Entity type:Individual
Prefix:
First Name:SHENGO
Middle Name:KIBRI
Last Name:DAWUD
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 1:470 WESTERN AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2292
Mailing Address - Country:US
Mailing Address - Phone:612-357-0642
Mailing Address - Fax:
Practice Address - Street 1:1001 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1065
Practice Address - Country:US
Practice Address - Phone:612-357-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician