Provider Demographics
NPI:1992015705
Name:CASTELLANOS, KALY (ARNP)
Entity Type:Individual
Prefix:
First Name:KALY
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SW 174TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029
Mailing Address - Country:US
Mailing Address - Phone:786-768-3980
Mailing Address - Fax:305-558-6080
Practice Address - Street 1:7950 NW 53RD ST UNIT 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-322-9029
Practice Address - Fax:786-329-6472
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46118111NR0400X
FLAPRN11001910363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111NR0400XChiropractic ProvidersChiropractorRehabilitation