Provider Demographics
NPI:1679851711
Name:CASILLAS CLAUDIO, KEILA (NP-C)
Entity Type:Individual
Prefix:
First Name:KEILA
Middle Name:
Last Name:CASILLAS CLAUDIO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1951
Mailing Address - Country:US
Mailing Address - Phone:617-425-2000
Mailing Address - Fax:617-425-2002
Practice Address - Street 1:400 SHAWMUT AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2006
Practice Address - Country:US
Practice Address - Phone:617-587-1900
Practice Address - Fax:617-587-1901
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NJ26NJ00675800363LF0000X
MARN2298448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered