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General NPI Number Information
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NPI Number | 1811623762
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Entity Type | Individual
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Provider Name | SHAUNQUETTE MITCHELL
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Gender | Female
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 2541 W MAIN ST
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City | LOUISVILLE
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State | KY
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Zip | 40212-1530
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Country | US
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Telephone | 859-444-2553
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 SAINT LOUIS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40210-1620
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Country | US
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Telephone |
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | KY
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