Healthcare Provider Details

I. General information

NPI: 1376474940
Provider Name (Legal Business Name): MELISSA GODOY HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

830 SE 1ST ST
HIALEAH FL
33010-5502
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-1093
  • Fax:
Mailing address:
  • Phone: 772-257-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11046610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: