Provider Demographics
NPI:1427882117
Name:MITCHELL, TYANA
Entity type:Individual
Prefix:
First Name:TYANA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 EUCLID AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2518
Mailing Address - Country:US
Mailing Address - Phone:216-776-8219
Mailing Address - Fax:
Practice Address - Street 1:3030 EUCLID AVE STE 410
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2518
Practice Address - Country:US
Practice Address - Phone:216-776-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker