Healthcare Provider Details

I. General information

NPI: 1962858670
Provider Name (Legal Business Name): AZLYN GOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BABCOCK ST STE 103
MELBOURNE FL
32935-7324
US

IV. Provider business mailing address

330 N BABCOCK ST STE 103
MELBOURNE FL
32935-7324
US

V. Phone/Fax

Practice location:
  • Phone: 321-321-6551
  • Fax: 321-204-7064
Mailing address:
  • Phone: 321-321-6551
  • Fax: 321-204-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number64058
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME157327
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME157327
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number64058
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: