Provider Demographics
NPI:1366535833
Name:CASTRELLO, ALICIA ROSE (FNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ROSE
Last Name:CASTRELLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7246 JANUS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4839
Mailing Address - Country:US
Mailing Address - Phone:315-458-3600
Mailing Address - Fax:315-458-2760
Practice Address - Street 1:7246 JANUS PARK DR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4839
Practice Address - Country:US
Practice Address - Phone:315-458-3600
Practice Address - Fax:315-458-2760
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3336751208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology