Provider Demographics
NPI:1568808574
Name:CASTRO, SHAMIL CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:SHAMIL
Middle Name:CRISTINA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAMIL
Other - Middle Name:CRISTINA
Other - Last Name:CORPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1301 HODGES DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4614
Mailing Address - Country:US
Mailing Address - Phone:850-431-5714
Mailing Address - Fax:850-431-6403
Practice Address - Street 1:1301 HODGES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4614
Practice Address - Country:US
Practice Address - Phone:850-431-5714
Practice Address - Fax:850-431-6403
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN18628207Q00000X
FLME124821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine