Provider Demographics
NPI:1922492693
Name:MITCHELL, ELENA (MSED)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24537 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2014
Mailing Address - Country:US
Mailing Address - Phone:718-728-8476
Mailing Address - Fax:718-229-7359
Practice Address - Street 1:24537 60TH AVE
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2014
Practice Address - Country:US
Practice Address - Phone:718-728-8476
Practice Address - Fax:718-229-7359
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist