Provider Demographics
NPI:1295457588
Name:DIAZ CASTRO, YURI PAMELA (SI 5871)
Entity type:Individual
Prefix:
First Name:YURI
Middle Name:PAMELA
Last Name:DIAZ CASTRO
Suffix:
Gender:F
Credentials:SI 5871
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W SEMINOLE BLVD APT 214
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7803
Mailing Address - Country:US
Mailing Address - Phone:787-477-3771
Mailing Address - Fax:
Practice Address - Street 1:111 E LAKE MARY BLVD # 113
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7111
Practice Address - Country:US
Practice Address - Phone:407-792-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI58712355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant