Healthcare Provider Details

I. General information

NPI: 1639551799
Provider Name (Legal Business Name): CHELSEA R. CASTELLONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA RIDDLE

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LITTLE MOUNTAIN RD
NINETY SIX SC
29666-9252
US

IV. Provider business mailing address

103 LITTLE MOUNTAIN RD
NINETY SIX SC
29666-9252
US

V. Phone/Fax

Practice location:
  • Phone: 864-543-3515
  • Fax: 864-543-2973
Mailing address:
  • Phone: 864-543-3515
  • Fax: 864-543-2973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMPA.2347 PA
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.5812 SPIN
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5812
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2347
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: