Individual provider Active NPI

Shevon Shataye Golladay

  • Registered Nurse
  • Toledo, OH
National Provider Identifier
1417754342
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
LPN.181449.MEDS-IV Issued in OH
Practice address
2005 Ashland Ave
Toledo, OH 43620-1703
Phone
(419) 841-7701
NPI assigned
Feb 27, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X LPN.181449.MEDS-IV OH Primary

Addresses

Primary practice location

2005 Ashland Ave
Toledo, OH 43620-1703

Mailing address

2005 Ashland Ave
Toledo, OH 43620-1703
Phone (419) 841-7701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LPN.181449.MEDS-IVOHMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1417754342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 ASHLAND AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436201703",
            "telephone_number": "419-841-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 ASHLAND AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436201703",
            "telephone_number": "419-841-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLADAY",
        "first_name": "SHEVON",
        "middle_name": "SHATAYE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-27",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "LPN.181449.MEDS-IV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.