MEDICARE: AMANDA LEIGH GOODS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA05831	TX
2	363AS0400X	Surgical Physician Assistant	PA22881	CA

General Provider Information

NPI Number	:	1558550806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEIGH GOODS P.A.

Provider Business Mailing Address
First Line	:	1988 GULF TO BAY BLVD
Second Line	:	STE 1
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3550
Country	:	US
Telephone Number	:	727-953-8090
Fax Number	:	727-953-8088

Provider Business Practice Location Address
First Line	:	3001 BEE CAVES RD
Second Line	:	STE 200
City	:	AUSTIN
State	:	TX
Zip	:	78746-5590
Country	:	US
Telephone Number	:	512-454-1234
Fax Number	:	512-472-7350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	06/20/2016

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Directions to “ AMANDA LEIGH GOODS P.A.” Practice Location

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