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NPI Code Detail

MEDICARE: FADUMO ABDISALAM FARAH

MEDICARE: FADUMO ABDISALAM FARAH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1568311140
Entity Type Code : Individual
Provider Name (Legal Business Name) : FADUMO ABDISALAM FARAH
Provider Business Mailing Address
First Line : 1200 CENTRE POINTE CURV STE 250
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1353
Country : US
Telephone Number : 651-402-8028
Fax Number : 651-402-8028
Provider Business Practice Location Address
First Line : 1200 CENTRE POINTE CURV STE 250
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1353
Country : US
Telephone Number : 651-402-8028
Fax Number : 651-402-8028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2026
Last Update Date : 02/02/2026

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Directions to “ FADUMO ABDISALAM FARAH ” Practice Location

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