Provider Demographics
NPI:1891679908
Name:MITCHEL, SHANIQUA SHARRAINE
Entity type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:SHARRAINE
Last Name:MITCHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARRAINE
Other - Middle Name:
Other - Last Name:NARRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1435 PARK PLACE AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6704
Mailing Address - Country:US
Mailing Address - Phone:678-923-5718
Mailing Address - Fax:
Practice Address - Street 1:1435 PARK PLACE AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6704
Practice Address - Country:US
Practice Address - Phone:678-923-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist