Healthcare Provider Details

I. General information

NPI: 1275460750
Provider Name (Legal Business Name): SUHAYB ABDULAHI ABDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 COUNTY ROAD B2 W STE 350
SAINT PAUL MN
55113-2735
US

IV. Provider business mailing address

1935 COUNTY ROAD B2 W STE 350
SAINT PAUL MN
55113-2735
US

V. Phone/Fax

Practice location:
  • Phone: 612-458-7852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1579515
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: