Healthcare Provider Details

I. General information

NPI: 1629442157
Provider Name (Legal Business Name): MAHAMED SALAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BOONE AVE N
NEW HOPE MN
55428-4838
US

IV. Provider business mailing address

4300 BOONE AVE N
NEW HOPE MN
55428-4838
US

V. Phone/Fax

Practice location:
  • Phone: 206-816-0521
  • Fax: 612-444-8907
Mailing address:
  • Phone: 206-816-0521
  • Fax: 612-444-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14736
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: