Provider Demographics
NPI:1861280729
Name:SALAZAR CASTELLANOS, ANDREA (RD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SALAZAR CASTELLANOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 18TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2473
Mailing Address - Country:US
Mailing Address - Phone:281-813-1911
Mailing Address - Fax:
Practice Address - Street 1:153 E 18TH ST APT 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2473
Practice Address - Country:US
Practice Address - Phone:281-813-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86294650133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered