Provider Demographics
NPI:1760699169
Name:MITCHEL, SHANNON MARIE (MD, PT)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARIE
Last Name:MITCHEL
Suffix:
Gender:F
Credentials:MD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 S LAMAR BLVD.
Mailing Address - Street 2:STE # D 109-134
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8864
Mailing Address - Country:US
Mailing Address - Phone:512-550-5513
Mailing Address - Fax:
Practice Address - Street 1:3005 S LAMAR BLVD
Practice Address - Street 2:STE D109-134
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8864
Practice Address - Country:US
Practice Address - Phone:512-550-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3898208D00000X
TX1088805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist