Healthcare Provider Details

I. General information

NPI: 1285546036
Provider Name (Legal Business Name): NUH SULEIBAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 OLD HUDSON RD # B11
SAINT PAUL MN
55119-4308
US

IV. Provider business mailing address

1865 OLD HUDSON RD # B11
SAINT PAUL MN
55119-4308
US

V. Phone/Fax

Practice location:
  • Phone: 612-232-2659
  • Fax:
Mailing address:
  • Phone: 651-271-7952
  • 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: