MEDICARE: SANDRA M MITCHELL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1235570979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA M MITCHELL PH.D.

Provider Business Mailing Address
First Line	:	1100 E DIMOND BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-2010
Country	:	US
Telephone Number	:	907-565-6000
Fax Number	:	907-565-6001

Provider Business Practice Location Address
First Line	:	1100 E DIMOND BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-2010
Country	:	US
Telephone Number	:	907-565-6000
Fax Number	:	907-565-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	02/17/2017

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