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NPI Code Detail

MEDICARE: SAMIRA B SALAD

MEDICARE: SAMIRA B SALAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystMN

General Provider Information

NPI Number : 1134843469
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMIRA B SALAD
Provider Business Mailing Address
First Line : 4008 MINNEHAHA AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-3306
Country : US
Telephone Number : 612-387-6968
Fax Number :
Provider Business Practice Location Address
First Line : 4008 MINNEHAHA AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-3306
Country : US
Telephone Number : 612-387-6968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2022
Last Update Date : 09/29/2022

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Directions to “ SAMIRA B SALAD ” Practice Location

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