Healthcare Provider Details

I. General information

NPI: 1679550172
Provider Name (Legal Business Name): DAVIDA Z. GOLDMAN PH.D., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 FRANCE AVE S SUITE 128
EDINA MN
55435-4300
US

IV. Provider business mailing address

4120 AVONDALE ST
MINNETONKA MN
55345-1805
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP4036
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4036
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4036
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: