Healthcare Provider Details

I. General information

NPI: 1235074030
Provider Name (Legal Business Name): SIHAM ABDIKADIR MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PARK AVE STE 100
MINNEAPOLIS MN
55404-3713
US

IV. Provider business mailing address

2400 PARK AVE STE 100
MINNEAPOLIS MN
55404-3713
US

V. Phone/Fax

Practice location:
  • Phone: 612-642-2666
  • Fax: 612-642-2875
Mailing address:
  • Phone: 612-642-2666
  • Fax: 612-642-2875

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: