MEDICARE: AZANAY MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1699621805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZANAY MITCHELL

Provider Business Mailing Address
First Line	:	2340 W HORIZON RIDGE PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3836 PRAIRIE ORCHID AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4029
Country	:	US
Telephone Number	:	702-610-2076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ AZANAY MITCHELL ” Practice Location

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