Provider Demographics
NPI:1881811958
Name:MITCHELL, HEATHER C
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WEST BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-716-4400
Mailing Address - Fax:718-228-7471
Practice Address - Street 1:2700 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4918
Practice Address - Country:US
Practice Address - Phone:718-708-4040
Practice Address - Fax:718-708-6040
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360491363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00590390OtherMEDICARE NUMBER
NY331822Medicaid
NYF360491OtherNP