Healthcare Provider Details

I. General information

NPI: 1801708623
Provider Name (Legal Business Name): ABDULAZIZ ABDULLAHI SHARIF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SOUTHCROSS DR W STE 302
BURNSVILLE MN
55306-7015
US

IV. Provider business mailing address

1505 SOUTHCROSS DR W STE 302
BURNSVILLE MN
55306-7015
US

V. Phone/Fax

Practice location:
  • Phone: 612-427-5204
  • Fax: 952-260-5070
Mailing address:
  • Phone: 612-427-5204
  • Fax: 952-260-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: