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NPI Code Detail

MEDICARE: AMAL AHMED MOHAMED

MEDICARE: AMAL AHMED MOHAMED
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
1103TM1800XIntellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number : 1104633106
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMAL AHMED MOHAMED
Provider Business Mailing Address
First Line : 9336 12TH AVE S
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2206
Country : US
Telephone Number : 612-242-3757
Fax Number :
Provider Business Practice Location Address
First Line : 938 6TH ST E
Second Line :
City : SAINT PAUL
State : MN
Zip : 55106-4504
Country : US
Telephone Number : 315-450-7121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2024
Last Update Date : 12/12/2024

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Directions to “ AMAL AHMED MOHAMED ” Practice Location

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