Healthcare Provider Details

I. General information

NPI: 1447935341
Provider Name (Legal Business Name): ZAHRA AMIR SHARIFMOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR STE 100
SAINT CLOUD MN
56303-1258
US

IV. Provider business mailing address

1555 NORTHWAY DR STE 100
SAINT CLOUD MN
56303-1258
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-1775
  • Fax:
Mailing address:
  • Phone: 320-251-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15294
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: