Healthcare Provider Details

I. General information

NPI: 1740635002
Provider Name (Legal Business Name): AMANDA GOLSHIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIDDLE AVE STE 204
NEWARK DE
19702-3972
US

IV. Provider business mailing address

300 BIDDLE AVE STE 204
NEWARK DE
19702-3972
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-4850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0001400
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberG0001400
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: