Provider Demographics
NPI:1659638179
Name:CASTILLO, SHARON PENALOSA
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:PENALOSA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:CABALLAR
Other - Last Name:PENALOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 S SERVICE RD
Mailing Address - Street 2:ROOM 109
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1036
Mailing Address - Country:US
Mailing Address - Phone:516-750-9760
Mailing Address - Fax:516-495-7242
Practice Address - Street 1:33 S SERVICE RD
Practice Address - Street 2:ROOM 109
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1036
Practice Address - Country:US
Practice Address - Phone:516-750-9760
Practice Address - Fax:516-495-7242
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2012-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist