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General NPI Number Information
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NPI Number | 1063418556
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Entity Type | Individual
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Provider Name | SHANTI BALKISSOON-CASTILLO DPM
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Gender | Female
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 8300 CARMEL AVE NE STE 501
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3125
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Country | US
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Telephone | 505-717-1274
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Fax | 505-717-1879
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Provider Business Mailing Address
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Address Line | 8300 CARMEL AVE NE STE 501
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3125
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Country | US
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Telephone | 505-717-1274
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Fax | 505-717-1879
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 286
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License Number State | NM
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