Provider Demographics
NPI:1174876965
Name:CASTELLO, LUENDA
Entity type:Individual
Prefix:
First Name:LUENDA
Middle Name:
Last Name:CASTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17705 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5825
Mailing Address - Country:US
Mailing Address - Phone:718-807-5460
Mailing Address - Fax:
Practice Address - Street 1:3270 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2643
Practice Address - Country:US
Practice Address - Phone:718-626-2699
Practice Address - Fax:718-626-0923
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
007858-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist