Provider Demographics
NPI:1598530164
Name:MITCHELL, SASHAUNA LOTAYA
Entity Type:Individual
Prefix:
First Name:SASHAUNA
Middle Name:LOTAYA
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 1:9505 BLUE STEM LN
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1330
Mailing Address - Country:US
Mailing Address - Phone:407-312-6737
Mailing Address - Fax:
Practice Address - Street 1:9505 BLUE STEM LN
Practice Address - Street 2:
Practice Address - City:OAK POINT
Practice Address - State:TX
Practice Address - Zip Code:75068-1330
Practice Address - Country:US
Practice Address - Phone:407-312-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-23
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142326363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care