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NPI Code Detail

MEDICARE: YUSUF AHMED MOHAMUD

MEDICARE: YUSUF AHMED MOHAMUD
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 : 1619859790
Entity Type Code : Individual
Provider Name (Legal Business Name) : YUSUF AHMED MOHAMUD
Provider Business Mailing Address
First Line : 2147 UNIVERSITY AVE W STE 108
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1326
Country : US
Telephone Number : 617-992-1536
Fax Number :
Provider Business Practice Location Address
First Line : 1509 27TH AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55418-3034
Country : US
Telephone Number : 617-992-1536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2025
Last Update Date : 07/21/2025

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