Healthcare Provider Details

I. General information

NPI: 1962321406
Provider Name (Legal Business Name): ASHA FARAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SHERMAN ST STE B40F
SAINT PAUL MN
55102-2527
US

IV. Provider business mailing address

360 SHERMAN ST STE B40F
SAINT PAUL MN
55102-2527
US

V. Phone/Fax

Practice location:
  • Phone: 612-440-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax: 612-440-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: