Healthcare Provider Details

I. General information

NPI: 1760597082
Provider Name (Legal Business Name): DANIEL FREDERICK SHREEVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HALL ST
CONCORD NH
03301-3488
US

IV. Provider business mailing address

807 WEST AVE
AUSTIN TX
78701-2207
US

V. Phone/Fax

Practice location:
  • Phone: 603-782-0316
  • Fax:
Mailing address:
  • Phone: 888-285-2269
  • Fax: 888-285-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13357
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.37327
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH8837
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number061584
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number016584
License Number StateME
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26049
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: