Provider Demographics
NPI:1407456452
Name:CASILLANO, ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:CASILLANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 DUTCH MILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2663
Mailing Address - Country:US
Mailing Address - Phone:937-672-5765
Mailing Address - Fax:
Practice Address - Street 1:2412 DUTCH MILL DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2663
Practice Address - Country:US
Practice Address - Phone:937-672-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide