Provider Demographics
NPI:1437565363
Name:CASTILLO, TARA A VAFIADOU (MS, CCC-SLP/TSSLD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:A VAFIADOU
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MS, CCC-SLP/TSSLD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:VAFIADOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP/TSSLD
Mailing Address - Street 1:7810 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 AVENUE S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2949
Practice Address - Country:US
Practice Address - Phone:718-339-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist