Healthcare Provider Details

I. General information

NPI: 1841105368
Provider Name (Legal Business Name): NANCY CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

300 PARK AVE
DEER PARK NY
11729-4941
US

IV. Provider business mailing address

300 PARK AVE
DEER PARK NY
11729-4941
US

V. Phone/Fax

Practice location:
  • Phone: 631-742-6929
  • Fax:
Mailing address:
  • Phone: 631-742-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: