Provider Demographics
NPI:1790344836
Name:CASTELLANO CRESPO, KERLLY PAOLA (AA)
Entity Type:Individual
Prefix:
First Name:KERLLY
Middle Name:PAOLA
Last Name:CASTELLANO CRESPO
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:KERLLY
Other - Middle Name:PAOLA
Other - Last Name:CASTELLANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 N LYNN ST APT 1615
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2025
Mailing Address - Country:US
Mailing Address - Phone:714-795-8721
Mailing Address - Fax:
Practice Address - Street 1:900 23RD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2342
Practice Address - Country:US
Practice Address - Phone:202-715-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAA000114367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant