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NPI Code Detail

MEDICARE: AMY GOODYEAR

MEDICARE:   AMY  GOODYEAR
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790129005
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY GOODYEAR
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 463-223-4591
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 3001 W SILVER SPRINGS BLVD BLDG 200
Second Line :
City : OCALA
State : FL
Zip : 34475-5647
Country : US
Telephone Number : 352-358-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2013
Last Update Date : 07/27/2023

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