Provider Information for 1518198746
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Dr. MICHELLE A. MITCHAM Ph.D.
Sex: Female
NPI: 1518198746
Last Updated: 2025-01-13
Certification Date: 2025-01-13
Certification Date: 2025-01-13
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1518198746 | ||||||||||||
| Enumeration Date | 2009-08-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4032 MCLAUGHLIN DR TALLAHASSEE, FL 32309-2759 United States Phone: 813-777-4028 | Fax: | ||||||||||||
| Primary Practice Address | 3035 ELIZA RD TALLAHASSEE, FL 32308-6243 United States Phone: 813-777-4028 | Fax: | ||||||||||||
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