Provider Demographics
NPI:1710334289
Name:MITCHELL, SHANTE
Entity Type:Individual
Prefix:
First Name:SHANTE
Middle Name:
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 1:1170 GREYSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7673
Mailing Address - Country:US
Mailing Address - Phone:419-270-4728
Mailing Address - Fax:419-386-5252
Practice Address - Street 1:1170 GREYSTONE PKWY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7673
Practice Address - Country:US
Practice Address - Phone:419-270-4728
Practice Address - Fax:419-386-5252
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care