Provider Demographics
NPI:1255207726
Name:VERA CASTANEDA, MAYKOLL ALEJANDRO
Entity type:Individual
Prefix:
First Name:MAYKOLL
Middle Name:ALEJANDRO
Last Name:VERA CASTANEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 SE 33RD TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4277
Mailing Address - Country:US
Mailing Address - Phone:786-571-3901
Mailing Address - Fax:
Practice Address - Street 1:1432 SE 33RD TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-4277
Practice Address - Country:US
Practice Address - Phone:786-571-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-479610106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician