Healthcare Provider Details

I. General information

NPI: 1609784701
Provider Name (Legal Business Name): SUMAYO MOHAMUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W STE 130N
SAINT PAUL MN
55114-1096
US

IV. Provider business mailing address

3026 15TH AVE S
SAINT CLOUD MN
56301-5688
US

V. Phone/Fax

Practice location:
  • Phone: 651-447-3755
  • Fax:
Mailing address:
  • Phone: 320-282-5237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14463
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: