Provider Demographics
NPI:1831354190
Name:MITCHELL, SHAWN B (PA-C)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1326 E LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3952
Mailing Address - Country:US
Mailing Address - Phone:757-583-6338
Mailing Address - Fax:757-531-9410
Practice Address - Street 1:1326 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3952
Practice Address - Country:US
Practice Address - Phone:757-583-6338
Practice Address - Fax:757-531-9410
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant