Provider Demographics
NPI:1245616937
Name:CASTANEDA, ANGELICA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 LEGACY VILLAS DR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7530
Mailing Address - Country:US
Mailing Address - Phone:407-492-5502
Mailing Address - Fax:
Practice Address - Street 1:2644 LEGACY VILLAS DR
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7530
Practice Address - Country:US
Practice Address - Phone:407-492-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist