Healthcare Provider Details

I. General information

NPI: 1922508357
Provider Name (Legal Business Name): DONALD J MITCHELL HAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4147 SUN N LAKE BLVD
SEBRING FL
33872-2131
US

IV. Provider business mailing address

4147 SUN N LAKE BLVD
SEBRING FL
33872-2131
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-0094
  • Fax: 863-402-0096
Mailing address:
  • Phone: 863-402-0094
  • Fax: 863-402-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS-5316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: