Provider Demographics
NPI:1073299350
Name:MITCHELL, SHEILA DENISE
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DENISE
Last Name:MITCHELL
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:N113W17121 DRIFTWOOD CT APT C
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-5816
Mailing Address - Country:US
Mailing Address - Phone:414-899-1152
Mailing Address - Fax:
Practice Address - Street 1:5420 N LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3006
Practice Address - Country:US
Practice Address - Phone:414-899-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty