Provider Demographics
NPI:1578374401
Name:SUGULLE, ABDIRAHMAN
Entity type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:
Last Name:SUGULLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CENTRE POINTE CURV STE 250
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1353
Mailing Address - Country:US
Mailing Address - Phone:651-402-8028
Mailing Address - Fax:
Practice Address - Street 1:1200 CENTRE POINTE CURV STE 250
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1353
Practice Address - Country:US
Practice Address - Phone:651-402-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician