Active NPI
Fardowsa A Mohamed
- Behavior Technician
- Columbia Heights, MN
National Provider Identifier
1164025466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4041 Central Ave NE
Columbia Heights, MN 55421-2900 - Phone
- (612) 666-0667
- NPI assigned
- Nov 18, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
4041 Central Ave NE
Columbia Heights, MN 55421-2900
Mailing address
2631 Columbus Ave Apt 211
Minneapolis, MN 55407-3726
Phone (612) 806-6030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1164025466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2631 COLUMBUS AVE APT 211",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073726",
"telephone_number": "612-806-6030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4041 CENTRAL AVE NE",
"city": "COLUMBIA HEIGHTS",
"state": "MN",
"postal_code": "554212900",
"telephone_number": "612-666-0667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMED",
"first_name": "FARDOWSA",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia Heights, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.