Individual
MR. JODY JAMES DECASTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1910 SASSAFRAS ST STE 300, ERIE, PA 16502-2716
(814) 452-7575
(814) 452-7574
Mailing address
152 FOOTE AVENUE, JAMESTOWN, NY 14701
(716) 664-5290
(716) 664-7630
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
015034
NY
363AM0700X
Medical Physician Assistant
Primary
MA055017
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12292814
CAQH
—
Enumeration date
09/12/2011
Last updated
10/07/2022
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