MEDICARE: NEURONEST WELLNESS

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1760371595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURONEST WELLNESS

Provider Business Mailing Address
First Line	:	4445 77TH ST W STE 102
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 77TH ST W STE 102
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5134
Country	:	US
Telephone Number	:	763-807-4146
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	MUHUMED MOHAMED
Credential	:
Telephone Number	:	763-807-4146

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	06/27/2025

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Directions to “NEURONEST WELLNESS ” Practice Location

Language	Start Address	Practice Location

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