Provider Demographics
NPI:1588931778
Name:GOLSON, SHIRDINA LAFAYE
Entity type:Individual
Prefix:
First Name:SHIRDINA
Middle Name:LAFAYE
Last Name:GOLSON
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 1:1412 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2904
Mailing Address - Country:US
Mailing Address - Phone:216-647-3697
Mailing Address - Fax:
Practice Address - Street 1:1412 VILLA DR
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2904
Practice Address - Country:US
Practice Address - Phone:216-647-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH348737163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse