Healthcare Provider Details

I. General information

NPI: 1124945266
Provider Name (Legal Business Name): MOHAMED SHURIYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 32ND AVE S STE 102
FARGO ND
58103-5911
US

IV. Provider business mailing address

4404 9TH AVENUE CIR S APT 305
FARGO ND
58103-7019
US

V. Phone/Fax

Practice location:
  • Phone: 701-799-8159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberSHU936150
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: