Healthcare Provider Details

I. General information

NPI: 1780025585
Provider Name (Legal Business Name): SHANNON MARIE GOLDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3666 PAXTON AVE
CINCINNATI OH
45208-1568
US

IV. Provider business mailing address

2744 MONTEREY CIR B
BEAVERCREEK OH
45431-1775
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-1183
  • Fax:
Mailing address:
  • Phone: 312-504-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number127700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: