Provider Demographics
NPI:1760597082
Name:SHREEVE, DANIEL FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:FREDERICK
Last Name:SHREEVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2207
Mailing Address - Country:US
Mailing Address - Phone:888-285-2269
Mailing Address - Fax:888-285-2269
Practice Address - Street 1:81 HALL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3488
Practice Address - Country:US
Practice Address - Phone:603-782-0316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH133572084P0800X
ALMD.373272084P0800X
TXH88372084P0800X
ME0615842084P0804X
ME0165842084P0800X
MS260492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME413090099Medicaid
MEME0879Medicare ID - Type Unspecified
D92829Medicare UPIN
ME413090099Medicaid