Provider Demographics
NPI:1205028420
Name:CASTRO-BORRERO, WANDA I (MD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:I
Last Name:CASTRO-BORRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-5357
Mailing Address - Country:US
Mailing Address - Phone:860-679-3186
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:NEUROLOGY
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-5357
Practice Address - Country:US
Practice Address - Phone:860-679-4888
Practice Address - Fax:860-679-1042
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0500682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1205028420Medicaid