Healthcare Provider Details

I. General information

NPI: 1740102995
Provider Name (Legal Business Name): NIYA SHARIF ABDELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 8TH ST S RM 115
SAINT CLOUD MN
56301-4423
US

IV. Provider business mailing address

151 8TH ST S RM 115
SAINT CLOUD MN
56301-4423
US

V. Phone/Fax

Practice location:
  • Phone: 320-308-3830
  • Fax: 320-308-3831
Mailing address:
  • Phone: 320-308-3830
  • Fax: 320-308-3831

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: