Healthcare Provider Details

I. General information

NPI: 1336648310
Provider Name (Legal Business Name): JANELLE MONIQUE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13590 SW 134TH AVE STE 104
MIAMI FL
33186-4575
US

IV. Provider business mailing address

114 NW 109TH AVE APT 108
PEMBROKE PINES FL
33026-5104
US

V. Phone/Fax

Practice location:
  • Phone: 786-637-5168
  • Fax:
Mailing address:
  • Phone: 954-670-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: