Healthcare Provider Details

I. General information

NPI: 1609794551
Provider Name (Legal Business Name): TYRA G MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PLAZA W
VALHALLA NY
10595-1579
US

IV. Provider business mailing address

81 S CHERRY ST
POUGHKEEPSIE NY
12601-4278
US

V. Phone/Fax

Practice location:
  • Phone: 347-631-3873
  • Fax:
Mailing address:
  • Phone: 347-631-3873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: