Healthcare Provider Details

I. General information

NPI: 1992642441
Provider Name (Legal Business Name): SUNDUS HASSAN IBRAHIM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 XERXES AVE S STE 116
BLOOMINGTON MN
55431-1200
US

IV. Provider business mailing address

382 NE 191ST ST STE 98090
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 651-431-6628
  • Fax:
Mailing address:
  • Phone: 651-431-6628
  • Fax: 919-561-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: