Active NPI
Anisa Sophia Mohammed, PSYD, LP
- Clinical Psychologist
- Shakopee, MN
National Provider Identifier
1215364625
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jan 18, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP5667
- Practice address
- 200 4TH Ave W
#300
Shakopee, MN 55379-1220 - Phone
- (952) 496-8614
- NPI assigned
- Sep 30, 2013
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP5667 | MN | Primary |
Addresses
Primary practice location
200 4TH Ave W
#300
Shakopee, MN 55379-1220
Mailing address
200 4TH Ave W
#300
Shakopee, MN 55379-1220
Phone (952) 496-8614
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP5667 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380499200000",
"number": "1215364625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 4TH AVE W",
"address_2": "#300",
"city": "SHAKOPEE",
"state": "MN",
"postal_code": "553791220",
"telephone_number": "952-496-8614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 4TH AVE W",
"address_2": "#300",
"city": "SHAKOPEE",
"state": "MN",
"postal_code": "553791220",
"telephone_number": "952-496-8614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMMED",
"first_name": "ANISA",
"middle_name": "SOPHIA",
"credential": "PSYD, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-30",
"last_updated": "2013-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP5667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shakopee, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.