Provider Demographics
NPI:1740620822
Name:GOLDEN, SHIVANI N (MD)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:N
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 1:10624 S EASTERN AVE STE A-955
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-407-7700
Mailing Address - Fax:
Practice Address - Street 1:10624 S EASTERN AVE STE A-955
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2982
Practice Address - Country:US
Practice Address - Phone:702-407-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287356207QG0300X, 207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NV1740620822Medicaid
NY331946Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331957Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY571056Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY00695941Medicaid
NY331058Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification