Healthcare Provider Details

I. General information

NPI: 1790927689
Provider Name (Legal Business Name): DANIEL NATHAN KASHDAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E MILLBROOK RD STE 110
RALEIGH NC
27609-5360
US

IV. Provider business mailing address

616 E MILLBROOK RD STE 110
RALEIGH NC
27609-5360
US

V. Phone/Fax

Practice location:
  • Phone: 804-748-9071
  • Fax: 910-346-1907
Mailing address:
  • Phone: 804-748-9071
  • Fax: 910-346-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177515
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: