Provider Demographics
NPI:1912861972
Name:DAHIR, ABDIFATAH MAHAT
Entity type:Individual
Prefix:
First Name:ABDIFATAH
Middle Name:MAHAT
Last Name:DAHIR
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 1:860 BLUE GENTIAN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1564
Mailing Address - Country:US
Mailing Address - Phone:612-261-7454
Mailing Address - Fax:612-248-1960
Practice Address - Street 1:860 BLUE GENTIAN RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55121-1564
Practice Address - Country:US
Practice Address - Phone:612-261-7454
Practice Address - Fax:612-248-1960
Is Sole Proprietor?:No
Enumeration Date:2025-12-15
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician