MEDICARE: FARDOSA AHMED

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

General Provider Information

NPI Number	:	1992412480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARDOSA AHMED

Provider Business Mailing Address
First Line	:	8427 KNOX AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55431-1760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8427 KNOX AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55431-1760
Country	:	US
Telephone Number	:	619-793-6154
Fax Number	:

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

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	01/22/2024

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Directions to “ FARDOSA AHMED ” Practice Location

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