Healthcare Provider Details

I. General information

NPI: 1457105579
Provider Name (Legal Business Name): HADIJATOU SANYANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JACKSON ST NE SUITE 100
MINNEAPOLIS MN
55413
US

IV. Provider business mailing address

2610 CUTTERS GROVE AVE APT# 205
ANOKA MN
55303
US

V. Phone/Fax

Practice location:
  • Phone: 612-353-6293
  • Fax:
Mailing address:
  • Phone: 612-707-1603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: