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NPI Code Detail

MEDICARE: AMIRA SICID SHIRE

MEDICARE: AMIRA SICID SHIRE
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1487373015
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMIRA SICID SHIRE
Provider Business Mailing Address
First Line : 1919 BROADWAY ST NE STE 120
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1253
Country : US
Telephone Number : 612-323-1871
Fax Number :
Provider Business Practice Location Address
First Line : 1919 BROADWAY ST NE STE 120
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1253
Country : US
Telephone Number : 612-323-1871
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2022
Last Update Date : 08/25/2022

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Directions to “ AMIRA SICID SHIRE ” Practice Location

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