Healthcare Provider Details

I. General information

NPI: 1467374389
Provider Name (Legal Business Name): TAYLOR NICOLE CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LAKEVILLE RD
NEW HYDE PARK NY
11042-1118
US

IV. Provider business mailing address

1563 208TH ST FL 2
BAYSIDE NY
11360-1119
US

V. Phone/Fax

Practice location:
  • Phone: 833-292-2019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number360374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: