Healthcare Provider Details

I. General information

NPI: 1114850658
Provider Name (Legal Business Name): XANDULE ASHER FARAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E 24TH ST APT 3
MINNEAPOLIS MN
55404-3831
US

IV. Provider business mailing address

1003 E 24TH ST APT 3
MINNEAPOLIS MN
55404-3831
US

V. Phone/Fax

Practice location:
  • Phone: 763-415-2568
  • Fax:
Mailing address:
  • Phone:
  • 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: