Provider Demographics
NPI:1487623609
Name:CASTELLANOS, AGUSTIN MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:MANUEL
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 BURNS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4353
Mailing Address - Country:US
Mailing Address - Phone:561-691-3500
Mailing Address - Fax:561-691-9779
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4353
Practice Address - Country:US
Practice Address - Phone:561-691-3500
Practice Address - Fax:561-691-9779
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL457642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14292Medicare UPIN
FLK1977Medicare ID - Type Unspecified