Provider Demographics
NPI:1801593405
Name:AHMED, SHAFI ALI
Entity type:Individual
Prefix:
First Name:SHAFI
Middle Name:ALI
Last Name:AHMED
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 1:1418 SUNRISE AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5963
Mailing Address - Country:US
Mailing Address - Phone:507-319-7346
Mailing Address - Fax:
Practice Address - Street 1:1418 SUNRISE AVE SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5963
Practice Address - Country:US
Practice Address - Phone:507-319-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician