Provider Demographics
NPI:1265314959
Name:MAIDEN, SHADIAMOND
Entity type:Individual
Prefix:
First Name:SHADIAMOND
Middle Name:
Last Name:MAIDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7632 ADORNMENT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4795
Mailing Address - Country:US
Mailing Address - Phone:909-223-5240
Mailing Address - Fax:
Practice Address - Street 1:2225 CIVIC CENTER DR STE 224
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6332
Practice Address - Country:US
Practice Address - Phone:702-773-8315
Practice Address - Fax:702-852-0661
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-6177172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker