Provider Demographics
NPI:1124791355
Name:CASTRO, JULEIDY (PA-C)
Entity type:Individual
Prefix:
First Name:JULEIDY
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7459 NW 178TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8434
Mailing Address - Country:US
Mailing Address - Phone:786-493-2775
Mailing Address - Fax:
Practice Address - Street 1:7867 N KENDALL DR STE 130
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7736
Practice Address - Country:US
Practice Address - Phone:305-598-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant