Provider Demographics
NPI:1902200280
Name:CHAMPAGNE, CASTELIA (MS ED)
Entity Type:Individual
Prefix:
First Name:CASTELIA
Middle Name:
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 SEWARD AVE
Mailing Address - Street 2:APT. 8C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2146
Mailing Address - Country:US
Mailing Address - Phone:718-823-9395
Mailing Address - Fax:
Practice Address - Street 1:2050 SEWARD AVE
Practice Address - Street 2:APT. 8C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2146
Practice Address - Country:US
Practice Address - Phone:718-823-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist