Healthcare Provider Details

I. General information

NPI: 1679851711
Provider Name (Legal Business Name): KEILA CASILLAS CLAUDIO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHAWMUT AVE
BOSTON MA
02118-2006
US

IV. Provider business mailing address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-587-1900
  • Fax: 617-587-1901
Mailing address:
  • Phone: 617-425-2000
  • Fax: 617-425-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2298448
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00675800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: