Provider Demographics
NPI:1740408731
Name:CASTRO, STELLA M (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6626
Mailing Address - Country:US
Mailing Address - Phone:315-663-0005
Mailing Address - Fax:315-663-0097
Practice Address - Street 1:4402 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 402
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6626
Practice Address - Country:US
Practice Address - Phone:315-663-0005
Practice Address - Fax:315-663-0097
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227714207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology