Healthcare Provider Details

I. General information

NPI: 1376458430
Provider Name (Legal Business Name): XAMDI A FARAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 EDINA INDUSTRIAL BLVD STE 130
EDINA MN
55439-2902
US

IV. Provider business mailing address

7345 BREN LN # 200
EDEN PRAIRIE MN
55346-4136
US

V. Phone/Fax

Practice location:
  • Phone: 651-395-9860
  • Fax:
Mailing address:
  • Phone: 651-395-9860
  • Fax:

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: