Provider Demographics
NPI:1700690864
Name:BASHIR, FAUSIA
Entity type:Individual
Prefix:
First Name:FAUSIA
Middle Name:
Last Name:BASHIR
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 1:3470 WASHINGTON DR STE 206
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1354
Mailing Address - Country:US
Mailing Address - Phone:651-505-9911
Mailing Address - Fax:651-505-9912
Practice Address - Street 1:3470 WASHINGTON DR STE 206
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1354
Practice Address - Country:US
Practice Address - Phone:651-505-9911
Practice Address - Fax:651-505-9912
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician