Healthcare Provider Details

I. General information

NPI: 1326286345
Provider Name (Legal Business Name): ALLEN R CASTELLO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 BLACKWOOD AVE
OCOEE FL
34761-4518
US

IV. Provider business mailing address

1173 BLACKWOOD AVE
OCOEE FL
34761-4518
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-4458
  • Fax: 407-877-4494
Mailing address:
  • Phone: 407-877-4458
  • Fax: 407-877-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME56679
License Number StateFL

VIII. Authorized Official

Name: MS. TRACY B KIAH PECK
Title or Position: BILLING MANAGER
Credential:
Phone: 407-877-4458