MEDICARE: ABDIRASHID MOHAMUD MOHAMED

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		MN

General Provider Information

NPI Number	:	1821945528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDIRASHID MOHAMUD MOHAMED

Provider Business Mailing Address
First Line	:	1821 UNIVERSITY AVE W STE 261-5
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2928
Country	:	US
Telephone Number	:	612-481-6172
Fax Number	:	612-444-8834

Provider Business Practice Location Address
First Line	:	1821 UNIVERSITY AVE W STE 261-5
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2928
Country	:	US
Telephone Number	:	612-481-6172
Fax Number	:	612-444-8834

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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