Provider Demographics
NPI:1194349811
Name:CASTELLANO, SANDRA (RD, RDN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16834 NW 89TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6105
Mailing Address - Country:US
Mailing Address - Phone:786-374-1880
Mailing Address - Fax:
Practice Address - Street 1:16834 NW 89TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-6105
Practice Address - Country:US
Practice Address - Phone:786-374-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered