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NPI Code Detail

MEDICARE: AZAHAR AHMED

MEDICARE: AZAHAR AHMED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1063379675
Entity Type Code : Individual
Provider Name (Legal Business Name) : AZAHAR AHMED
Provider Business Mailing Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 612-394-4012
Fax Number : 651-358-2604
Provider Business Practice Location Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 612-394-4012
Fax Number : 651-358-2604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “ AZAHAR AHMED ” Practice Location

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