Healthcare Provider Details

I. General information

NPI: 1154218931
Provider Name (Legal Business Name): SAMIRA EGALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 PARKWAY CIR STE 3006701
BROOKLYN CENTER MN
55430-2811
US

IV. Provider business mailing address

6701 PARKWAY CIR STE 300
BROOKLYN CENTER MN
55430-2849
US

V. Phone/Fax

Practice location:
  • Phone: 763-231-9094
  • Fax: 763-485-4404
Mailing address:
  • Phone: 763-231-9094
  • Fax:

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: