MEDICARE: DR. FERGIE STEPHANY DEDUY CASTRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		LA

General Provider Information

NPI Number	:	1720921091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERGIE STEPHANY DEDUY CASTRO

Provider Business Mailing Address
First Line	:	1835 PLATEAU VILLAGE DR UNIT 301
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-3979
Country	:	US
Telephone Number	:	863-277-0013
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 LAKE FOREST BLVD STE F
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2609
Country	:	US
Telephone Number	:	504-620-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ DR. FERGIE STEPHANY DEDUY CASTRO ” Practice Location

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