Provider Demographics
NPI:1164074746
Name:CASTELLANOS, STEPHANIE Y (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:Y
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:Y
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4200 REGENT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6229
Mailing Address - Country:US
Mailing Address - Phone:877-870-1775
Mailing Address - Fax:614-968-8840
Practice Address - Street 1:4200 REGENT ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6229
Practice Address - Country:US
Practice Address - Phone:877-870-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00935400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00935400OtherNJ APN LICENSE NUMBER