Healthcare Provider Details

I. General information

NPI: 1831778331
Provider Name (Legal Business Name): TONI NICASTRO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date: 05/05/2022
Reactivation Date: 06/03/2022

III. Provider practice location address

1705 W MAIN ST
MESA AZ
85201-6920
US

IV. Provider business mailing address

3033 N CENTRAL AVE STE 145
PHOENIX AZ
85012-2808
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax:
Mailing address:
  • Phone: 623-583-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5151015562
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number011629
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: