Provider Demographics
NPI:1649033408
Name:MITCHELL, SHANNON NICHOLE (CNA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICHOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1478
Mailing Address - Country:US
Mailing Address - Phone:202-910-6091
Mailing Address - Fax:
Practice Address - Street 1:6404 BROOKE JANE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4123
Practice Address - Country:US
Practice Address - Phone:202-910-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00202787251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care