Healthcare Provider Details

I. General information

NPI: 1689434458
Provider Name (Legal Business Name): DEVON MITCHELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 06/13/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST
RICHMOND VA
23298-5024
US

IV. Provider business mailing address

1200 E BROAD ST # 980257
RICHMOND VA
23298-5025
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9165
  • Fax: 804-828-4493
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0116041090
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.083486
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: