Healthcare Provider Details

I. General information

NPI: 1073449328
Provider Name (Legal Business Name): ABDULLAHI ABDULLAHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 UNIVERSITY AVE NE
MINNEAPOLIS MN
55432-3134
US

IV. Provider business mailing address

3911 FREMONT AVE N
MINNEAPOLIS MN
55412-2044
US

V. Phone/Fax

Practice location:
  • Phone: 612-298-7636
  • Fax:
Mailing address:
  • Phone:
  • 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: