Provider Demographics
NPI:1962259754
Name:MITCHELL, SHELLEY ANTOINETTE
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANTOINETTE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:ANTOINETTE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11407 MANGLA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8885
Mailing Address - Country:US
Mailing Address - Phone:704-754-2532
Mailing Address - Fax:
Practice Address - Street 1:11407 MANGLA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-8885
Practice Address - Country:US
Practice Address - Phone:704-754-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company