Provider Demographics
NPI:1508320250
Name:MITCHELL, MIYAH CHARRAY (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MS
First Name:MIYAH
Middle Name:CHARRAY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 WINDING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2922
Mailing Address - Country:US
Mailing Address - Phone:817-673-1366
Mailing Address - Fax:
Practice Address - Street 1:1303 WINDING BROOK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2922
Practice Address - Country:US
Practice Address - Phone:817-673-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist