Healthcare Provider Details

I. General information

NPI: 1447592464
Provider Name (Legal Business Name): AMY K BODART DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S APOLLO BLVD
MELBOURNE FL
32901-4615
US

IV. Provider business mailing address

4101 CHARLOTTE AVE STE F185
NASHVILLE TN
37209-4066
US

V. Phone/Fax

Practice location:
  • Phone: 321-204-0279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2236
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: