Provider Demographics
NPI:1629843206
Name:MITCHELIN, DAVIANNA
Entity Type:Individual
Prefix:
First Name:DAVIANNA
Middle Name:
Last Name:MITCHELIN
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 1:192 E 55TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3753
Mailing Address - Country:US
Mailing Address - Phone:212-920-0298
Mailing Address - Fax:
Practice Address - Street 1:192 E 55TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3753
Practice Address - Country:US
Practice Address - Phone:212-920-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst