Healthcare Provider Details

I. General information

NPI: 1881842318
Provider Name (Legal Business Name): TERRY MITCHELL CHARONNAT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRY L. MITCHELL M.S.

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 52ND ST SUITE 4200
OAKLAND CA
94609-1810
US

IV. Provider business mailing address

PO BOX 5538
BERKELEY CA
94705-0538
US

V. Phone/Fax

Practice location:
  • Phone: 510-658-3277
  • Fax: 877-769-9966
Mailing address:
  • Phone: 510-658-3277
  • Fax: 877-769-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU 508
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA 1980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: