Provider Demographics
NPI:1841962826
Name:MITCHELL, STEPHANIE CECILIA (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CECILIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
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 620234
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0103
Mailing Address - Country:US
Mailing Address - Phone:848-333-5898
Mailing Address - Fax:
Practice Address - Street 1:3545 WHITEHALL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4179
Practice Address - Country:US
Practice Address - Phone:848-333-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06607600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine