Healthcare Provider Details

I. General information

NPI: 1205771318
Provider Name (Legal Business Name): HAMDI AHMED FARAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 JEFFERSON LN N
BROOKLYN PARK MN
55445-2115
US

IV. Provider business mailing address

8503 JEFFERSON LN N
BROOKLYN PARK MN
55445-2115
US

V. Phone/Fax

Practice location:
  • Phone: 763-269-9740
  • Fax:
Mailing address:
  • Phone: 763-269-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1123083
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: