Healthcare Provider Details

I. General information

NPI: 1235862830
Provider Name (Legal Business Name): RAYAN MOHAMMED ABAKAR SIBIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date: 03/13/2023
Reactivation Date: 08/06/2026

III. Provider practice location address

420 DELAWARE ST SE MMC 609, MAYO D142
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 609, MAYO D142
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-8133
  • Fax:
Mailing address:
  • Phone: 612-624-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: