Provider Demographics
NPI:1245944933
Name:ALI, NASTAHO MOHAMED
Entity type:Individual
Prefix:
First Name:NASTAHO
Middle Name:MOHAMED
Last Name:ALI
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 1:145 HAMEL RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55340-9535
Mailing Address - Country:US
Mailing Address - Phone:612-756-9107
Mailing Address - Fax:
Practice Address - Street 1:1360 STAGECOACH RD UNIT 423
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-8064
Practice Address - Country:US
Practice Address - Phone:507-530-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0000000000OtherN/A