Provider Demographics
NPI:1942568142
Name:CASTRO, AMANDA CASSEL (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CASSEL
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CASSEL
Other - Last Name:SWANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2300 PENNSYLVANIA AVE STE 4C
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1338
Mailing Address - Country:US
Mailing Address - Phone:302-635-0517
Mailing Address - Fax:302-651-4543
Practice Address - Street 1:2300 PENNSYLVANIA AVE STE 4C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1338
Practice Address - Country:US
Practice Address - Phone:302-635-0517
Practice Address - Fax:570-221-6246
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DEC1-00123282084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty