Healthcare Provider Details

I. General information

NPI: 1356321400
Provider Name (Legal Business Name): MELODEE ANNE GOODIER AMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 RESCUE WAY
CLEARWATER FL
33762
US

IV. Provider business mailing address

430 MORTON PLANT STREET SUITE 402
CLEARWATER FL
33756
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax: 727-535-4190
Mailing address:
  • Phone: 727-461-8635
  • Fax: 727-461-8648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number160234-16
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: