Provider Demographics
NPI:1942759311
Name:CASTRO, MICHELLE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2520
Mailing Address - Country:US
Mailing Address - Phone:201-218-3420
Mailing Address - Fax:201-343-7410
Practice Address - Street 1:710 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2520
Practice Address - Country:US
Practice Address - Phone:201-218-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00551200363LA2200X
NY309225363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health