Provider Demographics
NPI:1588438477
Name:DE CASTRO, MILENA
Entity type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PINE VALLEY RD APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1459
Mailing Address - Country:US
Mailing Address - Phone:386-307-3828
Mailing Address - Fax:
Practice Address - Street 1:103 BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5713
Practice Address - Country:US
Practice Address - Phone:407-907-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician