Healthcare Provider Details

I. General information

NPI: 1891594479
Provider Name (Legal Business Name): SAIDI D SIMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

1770 132ND LN NE
BLAINE MN
55449-4138
US

V. Phone/Fax

Practice location:
  • Phone: 507-779-4021
  • Fax:
Mailing address:
  • Phone: 507-779-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13268
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: