Healthcare Provider Details

I. General information

NPI: 1437979549
Provider Name (Legal Business Name): ABDULAKDIR ALI HASSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3353 CLEVELAND AVE STE 76
COLUMBUS OH
43224-3644
US

IV. Provider business mailing address

3353 CLEVELAND AVE STE 76
COLUMBUS OH
43224-3644
US

V. Phone/Fax

Practice location:
  • Phone: 614-632-1222
  • Fax:
Mailing address:
  • Phone: 614-632-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number202428402048
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: