Provider Demographics
NPI:1568251965
Name:MITCHELL, SHONTA TAYLOR (FNP)
Entity type:Individual
Prefix:
First Name:SHONTA
Middle Name:TAYLOR
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 INDIANGRASS CV
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-8411
Mailing Address - Country:US
Mailing Address - Phone:803-394-4257
Mailing Address - Fax:
Practice Address - Street 1:425 N SALEM AVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4115
Practice Address - Country:US
Practice Address - Phone:803-774-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily