Provider Demographics
NPI:1639551799
Name:CASTELLONE, CHELSEA R (PA-C)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:R
Last Name:CASTELLONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:RIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 LITTLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NINETY SIX
Mailing Address - State:SC
Mailing Address - Zip Code:29666-9252
Mailing Address - Country:US
Mailing Address - Phone:864-543-3515
Mailing Address - Fax:864-543-2973
Practice Address - Street 1:103 LITTLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NINETY SIX
Practice Address - State:SC
Practice Address - Zip Code:29666-9252
Practice Address - Country:US
Practice Address - Phone:864-543-3515
Practice Address - Fax:864-543-2973
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.2347 PA363AM0700X
SCSLP.5812 SPIN235Z00000X
SC5812235Z00000X
SC2347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2269PAMedicaid