Provider Demographics
NPI:1235967175
Name:IBRAHIM, SADIYA M
Entity type:Individual
Prefix:
First Name:SADIYA
Middle Name:M
Last Name:IBRAHIM
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 1:201 W BURNSVILLE PKWY STE 130H
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2527
Mailing Address - Country:US
Mailing Address - Phone:952-500-2206
Mailing Address - Fax:
Practice Address - Street 1:14041 BURNHAVEN DR STE 150
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4442
Practice Address - Country:US
Practice Address - Phone:952-500-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician