Provider Demographics
NPI:1689967770
Name:CASTELLANOS, TONIA (SLP)
Entity Type:Individual
Prefix:MS
First Name:TONIA
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:
Other - Last Name:LATESTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1110 SW 110TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4122
Mailing Address - Country:US
Mailing Address - Phone:954-914-2605
Mailing Address - Fax:
Practice Address - Street 1:1110 SW 110TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4122
Practice Address - Country:US
Practice Address - Phone:954-914-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5165235Z00000X
FLSA11573222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist