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NPI Code Detail

MEDICARE: AFIFA MUHAMDE FEYESSO

MEDICARE: AFIFA MUHAMDE FEYESSO
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 TechnicianMN

General Provider Information

NPI Number : 1629884747
Entity Type Code : Individual
Provider Name (Legal Business Name) : AFIFA MUHAMDE FEYESSO
Provider Business Mailing Address
First Line : 5243 99TH CIR N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-5433
Country : US
Telephone Number : 612-458-7457
Fax Number : 612-354-3801
Provider Business Practice Location Address
First Line : 7205 UNIVERSITY AVE NE
Second Line :
City : FRIDLEY
State : MN
Zip : 55432-3134
Country : US
Telephone Number : 612-298-7636
Fax Number : 612-354-3801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2024
Last Update Date : 12/04/2024

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Directions to “ AFIFA MUHAMDE FEYESSO ” Practice Location

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