Provider Demographics
NPI:1134016843
Name:MITCHELL, TANISHA
Entity type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8607 WINTERGREEN CT UNIT 405
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3855
Mailing Address - Country:US
Mailing Address - Phone:718-570-4169
Mailing Address - Fax:
Practice Address - Street 1:5457 TWIN KNOLLS ROAD
Practice Address - Street 2:3RD FLOOR, #170
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:844-433-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist