Provider Demographics
NPI:1689417669
Name:CASTILLO MOREL, VIELKA ILEANA
Entity type:Individual
Prefix:
First Name:VIELKA
Middle Name:ILEANA
Last Name:CASTILLO MOREL
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 1:2794 SEDGWICK AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-2453
Mailing Address - Country:US
Mailing Address - Phone:646-339-6359
Mailing Address - Fax:
Practice Address - Street 1:2794 SEDGWICK AVE APT 3D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-2453
Practice Address - Country:US
Practice Address - Phone:646-339-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist