Healthcare Provider Details

I. General information

NPI: 1285556407
Provider Name (Legal Business Name): ENDRYSA E PEGUERO-CASTILLO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 E ADAMO DR STE 238B
TAMPA FL
33605-5919
US

IV. Provider business mailing address

4951 E ADAMO DR STE 238B
TAMPA FL
33605-5919
US

V. Phone/Fax

Practice location:
  • Phone: 813-545-7752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: