Provider Demographics
NPI:1053176107
Name:ABDURAHMAN, SAMIRA YUSUF
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:YUSUF
Last Name:ABDURAHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10273 YELLOW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9144
Mailing Address - Country:US
Mailing Address - Phone:612-638-7360
Mailing Address - Fax:
Practice Address - Street 1:3109 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2124
Practice Address - Country:US
Practice Address - Phone:612-638-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician