Healthcare Provider Details

I. General information

NPI: 1801055843
Provider Name (Legal Business Name): CHESNEY DAWN CASTLEBERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 01/05/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E 32ND ST
AUSTIN TX
78722-2211
US

IV. Provider business mailing address

4314 MEDICAL PKWY
AUSTIN TX
78756-3334
US

V. Phone/Fax

Practice location:
  • Phone: 210-722-2437
  • Fax:
Mailing address:
  • Phone: 512-454-1110
  • Fax: 512-793-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberS2561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: