Provider Demographics
NPI:1982242343
Name:CASTRO, MALLELYN (RN)
Entity Type:Individual
Prefix:
First Name:MALLELYN
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7628
Mailing Address - Country:US
Mailing Address - Phone:305-824-0637
Mailing Address - Fax:305-824-0628
Practice Address - Street 1:4385 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7628
Practice Address - Country:US
Practice Address - Phone:305-824-0637
Practice Address - Fax:305-824-0628
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030851363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9399673OtherLICENSE