Provider Demographics
NPI:1033615414
Name:CASTANEDO, YEISEL (MD)
Entity Type:Individual
Prefix:
First Name:YEISEL
Middle Name:
Last Name:CASTANEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YEISEL
Other - Middle Name:
Other - Last Name:ALFONSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14764 SW 70TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1027
Mailing Address - Country:US
Mailing Address - Phone:786-442-7575
Mailing Address - Fax:
Practice Address - Street 1:2131 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7407
Practice Address - Country:US
Practice Address - Phone:910-667-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC239050390200000X
FLME152142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program