Provider Demographics
NPI:1457440034
Name:MITCHELL, SHAUNNA SUE (DO)
Entity Type:Individual
Prefix:
First Name:SHAUNNA
Middle Name:SUE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 TECHNOLOGY CTR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2697
Mailing Address - Country:US
Mailing Address - Phone:903-247-0484
Mailing Address - Fax:903-247-0485
Practice Address - Street 1:402 N KAUFMAN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TX
Practice Address - Zip Code:75563-5234
Practice Address - Country:US
Practice Address - Phone:903-756-5581
Practice Address - Fax:903-756-5005
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF88225Medicare UPIN