MEDICARE: ANAMARILIS GODDARD

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	106S00000X	Behavior Technician	24334026	FL

General Provider Information

NPI Number	:	1982441846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAMARILIS GODDARD

Provider Business Mailing Address
First Line	:	7200 NW 177TH ST APT 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6234
Country	:	US
Telephone Number	:	786-912-8458
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 NORTH DR # 142
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33179-3545
Country	:	US
Telephone Number	:	786-912-8458
Fax Number	:

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

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	03/16/2026

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Directions to “ ANAMARILIS GODDARD ” Practice Location

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