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General NPI Number Information
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NPI Number | 1619554268
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Entity Type | Individual
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Provider Name | JASON ALEXANDER SHUGOLL MD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 630 PETER JEFFERSON PKWY STE 130
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-4624
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Country | US
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Telephone | 434-201-2155
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 LEE ST MAIL STOP 801210
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0816
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Country | US
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Telephone | 434-924-5314
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Fax | 434-243-4743
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101280026
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License Number State | VA
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