Healthcare Provider Details

I. General information

NPI: 1598628836
Provider Name (Legal Business Name): SHAMSA AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23298 124TH AVE
ROGERS MN
55374-5007
US

IV. Provider business mailing address

23298 124TH AVE
ROGERS MN
55374-5007
US

V. Phone/Fax

Practice location:
  • Phone: 320-495-9957
  • Fax:
Mailing address:
  • Phone: 320-405-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: