MEDICARE: AMAL M ABDINUR

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1407575707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMAL M ABDINUR

Provider Business Mailing Address
First Line	:	540 FAIRVIEW AVE N STE 303
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1796
Country	:	US
Telephone Number	:	347-677-3941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 HURON RD E APT 505
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1755
Country	:	US
Telephone Number	:	507-202-5406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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Directions to “ AMAL M ABDINUR ” Practice Location

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