Healthcare Provider Details

I. General information

NPI: 1396689444
Provider Name (Legal Business Name): ABDI GULED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S TUCKER BLVD
SAINT LOUIS MO
63104-3205
US

IV. Provider business mailing address

1321 S TUCKER BLVD
SAINT LOUIS MO
63104-3205
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-9205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: