Active NPI
Hudaifa Dahir Mohamud
- Behavior Technician
- Fridley, MN
National Provider Identifier
1679270029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 7205 University Ave NE
Fridley, MN 55432-3134 - Phone
- (612) 208-0729
- Fax
- (612) 354-3801
- NPI assigned
- Feb 15, 2023
- Sex
- Male
- 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 | MN | Primary |
Addresses
Primary practice location
7205 University Ave NE
Fridley, MN 55432-3134
Mailing address
6030 Main St NE Apt 206
Fridley, MN 55432-2870
Phone (712) 259-9137
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": "1676419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676419200000",
"number": "1679270029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6030 MAIN ST NE APT 206",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554322870",
"telephone_number": "712-259-9137",
"fax_number": "612-354-3801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7205 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554323134",
"telephone_number": "612-208-0729",
"fax_number": "612-354-3801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMUD",
"first_name": "HUDAIFA",
"middle_name": "DAHIR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-02-15",
"last_updated": "2023-02-15",
"certification_date": "2023-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.