Provider Demographics
NPI:1801266051
Name:MITCHUM, SANDRA
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:MITCHUM
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 1:1701 COVEMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5408
Mailing Address - Country:US
Mailing Address - Phone:214-729-0836
Mailing Address - Fax:817-795-1173
Practice Address - Street 1:1701 COVEMEADOW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-5408
Practice Address - Country:US
Practice Address - Phone:214-729-0836
Practice Address - Fax:817-795-1173
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor