Provider Demographics
NPI:1407846512
Name:GOLDEN, NANIALEI (MD)
Entity Type:Individual
Prefix:
First Name:NANIALEI
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-725-4500
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1130 HICKORY ST STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-725-4500
Practice Address - Fax:321-952-2330
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME760342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254192100Medicaid
FL43801WOtherMEDICARE
FLP00150108OtherRR MEDICARE
G78027Medicare UPIN
FL43801OtherBCBS