Healthcare Provider Details

I. General information

NPI: 1952054264
Provider Name (Legal Business Name): SOPHIA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MORRISTOWN RD
BASKING RIDGE NJ
07920-1654
US

IV. Provider business mailing address

131 MORRISTOWN RD
BASKING RIDGE NJ
07920-1654
US

V. Phone/Fax

Practice location:
  • Phone: 551-218-7353
  • Fax: 855-663-6117
Mailing address:
  • Phone: 551-218-7353
  • Fax: 855-663-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310608-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: