Provider Demographics
NPI:1184261067
Name:MITCHELL, SHAFAUNIS
Entity type:Individual
Prefix:
First Name:SHAFAUNIS
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:PO BOX 1552
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-1552
Mailing Address - Country:US
Mailing Address - Phone:478-956-4916
Mailing Address - Fax:478-956-0958
Practice Address - Street 1:100 HAMILTON POINTE DR STE 115
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6271
Practice Address - Country:US
Practice Address - Phone:478-845-3520
Practice Address - Fax:478-956-0958
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty