Healthcare Provider Details

I. General information

NPI: 1972467264
Provider Name (Legal Business Name): SEMAJ THREATS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WOODDALE DR STE 200
WOODBURY MN
55125-2920
US

IV. Provider business mailing address

382 NE 191ST ST STE 98090
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 651-431-6628
  • Fax: 919-561-6612
Mailing address:
  • Phone: 651-431-6628
  • Fax: 919-561-6612

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: