Healthcare Provider Details

I. General information

NPI: 1881811958
Provider Name (Legal Business Name): HEATHER C MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 GRAND CONCOURSE
BRONX NY
10458-4918
US

IV. Provider business mailing address

85 WEST BURNSIDE AVE
BRONX NY
10453
US

V. Phone/Fax

Practice location:
  • Phone: 718-708-4040
  • Fax: 718-708-6040
Mailing address:
  • Phone: 718-716-4400
  • Fax: 718-228-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: