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NPI Code Detail

MEDICARE: MS. SYNTHIA LYNN GOODE MSED, ATC

MEDICARE: MS. SYNTHIA LYNN GOODE MSED, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer1329NC
22255A2300XAthletic Trainer126000861VA

General Provider Information

NPI Number : 1376755363
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SYNTHIA LYNN GOODE MSED, ATC
Provider Business Mailing Address
First Line : 5312 BLEECKER ST
Second Line : UNIT 304
City : VIRGINIA BEACH
State : VA
Zip : 23462-3958
Country : US
Telephone Number : 757-561-3431
Fax Number : 757-213-7968
Provider Business Practice Location Address
First Line : 184 BUSINESS PARK DR
Second Line : STE 100
City : VIRGINIA BEACH
State : VA
Zip : 23462-6533
Country : US
Telephone Number : 757-561-3431
Fax Number : 757-213-7968
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 10/02/2013

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