Provider Demographics
NPI:1396528766
Name:CASTELLANOS, EDUARDO ANDRES
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ANDRES
Last Name:CASTELLANOS
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 1:15967 W WIND CIR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2146
Mailing Address - Country:US
Mailing Address - Phone:954-292-0839
Mailing Address - Fax:
Practice Address - Street 1:6299 W SUNRISE BLVD STE 108
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6177
Practice Address - Country:US
Practice Address - Phone:954-533-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health