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General NPI Number Information
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NPI Number | 1033603899
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Entity Type | Individual
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Provider Name | VANESSA MONIQUE MITCHELL MD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 3487 NW 30TH ST
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-1103
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Country | US
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Telephone | 872-231-3162
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 734951
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City | CHICAGO
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State | IL
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Zip | 60673-4951
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Country | US
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Telephone | 702-899-0595
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Fax | 702-977-1496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME151167
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License Number State | FL
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