MEDICARE: DANIELLE GODFREY RN,MSN,RNC-MNN,IBCLC

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	163WM0102X	Maternal Newborn Registered Nurse	9565465	FL
2	163WL0100X	Lactation Consultant (Registered Nurse)	9565465	FL

General Provider Information

NPI Number	:	1720794613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE GODFREY RN,MSN,RNC-MNN,IBCLC

Provider Business Mailing Address
First Line	:	960 COUNTRYSIDE WEST BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-7988
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 S NOVA RD STE 111
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3796
Country	:	US
Telephone Number	:	386-310-9401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	04/22/2025

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