Provider Demographics
NPI:1912896333
Name:CASTELUCCI, REVA
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:
Last Name:CASTELUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 BAY RD SE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9658
Mailing Address - Country:US
Mailing Address - Phone:330-491-6845
Mailing Address - Fax:330-491-6845
Practice Address - Street 1:3211 BAY RD SE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-9658
Practice Address - Country:US
Practice Address - Phone:330-491-6845
Practice Address - Fax:330-491-6845
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker