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General NPI Number Information
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NPI Number | 1104366657
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Entity Type | Individual
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Provider Name | BECKY YEN MITCHELL
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Gender | Female
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1 LAUTERBUR DRIVE
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City | STONY BROOK
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State | NY
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Zip | 11794-3733
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Country | US
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Telephone | 408-828-3211
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Fax |
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Provider Business Mailing Address
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Address Line | 9 N MCCONNELL AVE
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City | BAYPORT
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State | NY
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Zip | 11705-1248
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Country | US
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Telephone | 408-828-3211
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 020541-1
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License Number State | NY
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