Healthcare Provider Details

I. General information

NPI: 1932760402
Provider Name (Legal Business Name): MAGDALENA CASTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N TRYON ST STE 1600
CHARLOTTE NC
28202-0213
US

IV. Provider business mailing address

206 MUSTANG CT
GAMBRILLS MD
21054-1133
US

V. Phone/Fax

Practice location:
  • Phone: 845-209-1634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52252
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: