Healthcare Provider Details

I. General information

NPI: 1740620822
Provider Name (Legal Business Name): SHIVANI N GOLDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10624 S EASTERN AVE STE A-955
HENDERSON NV
89052-2982
US

IV. Provider business mailing address

10624 S EASTERN AVE STE A-955
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 702-407-7700
  • Fax:
Mailing address:
  • Phone: 702-407-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number287356
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number287356
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number287356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: