MEDICARE: SHEKINAH 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	225100000X	Physical Therapist	PTT43235	FL
2	225100000X	Physical Therapist	PT43235	FL

General Provider Information

NPI Number	:	1770479651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEKINAH MITCHELL

Provider Business Mailing Address
First Line	:	1885 GREEN ISLAND CIR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-2602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 EASTWEST PKWY STE 11
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-5310
Country	:	US
Telephone Number	:	904-215-3958
Fax Number	:

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

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	08/14/2025

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