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General NPI Number Information
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NPI Number | 1568251965
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Entity Type | Individual
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Provider Name | SHONTA TAYLOR MITCHELL FNP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 425 N SALEM AVE
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City | SUMTER
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State | SC
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Zip | 29150-4115
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Country | US
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Telephone | 803-774-4541
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Fax |
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Provider Business Mailing Address
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Address Line | 2135 INDIANGRASS CV
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City | SUMTER
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State | SC
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Zip | 29153-8411
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Country | US
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Telephone | 803-394-4257
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 30239
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License Number State | SC
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