Healthcare Provider Details

I. General information

NPI: 1629417282
Provider Name (Legal Business Name): AMANDA MARIE CHICCARELLI D.O, M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIE GOSS D.O, M.A

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 S BROADWAY STE 100
LITTLETON CO
80122-2633
US

IV. Provider business mailing address

383 PORTA ROSA CIR
ST AUGUSTINE FL
32092-4760
US

V. Phone/Fax

Practice location:
  • Phone: 303-798-9996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0076956
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0102205886
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: