Provider Demographics
NPI:1003359449
Name:MITCHELL, ANIA (RD)
Entity Type:Individual
Prefix:
First Name:ANIA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GREENVIEW TER
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8741
Mailing Address - Country:US
Mailing Address - Phone:203-543-5786
Mailing Address - Fax:
Practice Address - Street 1:80 SHUNPIKE RD
Practice Address - Street 2:UNIT 101A
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4402
Practice Address - Country:US
Practice Address - Phone:203-543-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001072133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered