MEDICARE: GOFFE HEALTH AND WELLNESS LLC

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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1518821495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOFFE HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1334 SULPHUR SPRING (927 RADALLSTOWN, MD 21133)
Second Line	:
City	:	HALETHORPE
State	:	MD
Zip	:	21227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 SULPHUR SPRING
Second Line	:
City	:	HALETHORPE
State	:	MD
Zip	:	21227
Country	:	US
Telephone Number	:	410-935-7227
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VANESHA GOFFE
Credential	:	DNP
Telephone Number	:	763-670-5449

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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