Provider Demographics
NPI:1225725385
Name:MITCHELL, ALISSHA RENEE
Entity Type:Individual
Prefix:
First Name:ALISSHA
Middle Name:RENEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHINYSTARS HOMECARE
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1409 WASHINGTON AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1936
Mailing Address - Country:US
Mailing Address - Phone:314-798-5881
Mailing Address - Fax:314-866-8087
Practice Address - Street 1:1409 WASHINGTON AVE STE 211
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1936
Practice Address - Country:US
Practice Address - Phone:314-798-5881
Practice Address - Fax:314-866-8087
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant