Provider Demographics
NPI:1265267199
Name:MITCHELL, ROBERT T (CNC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 SLIGO CREEK PKWY APT 608
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3349
Mailing Address - Country:US
Mailing Address - Phone:202-696-3337
Mailing Address - Fax:
Practice Address - Street 1:9039 SLIGO CREEK PKWY APT 608
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-3349
Practice Address - Country:US
Practice Address - Phone:202-696-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education