Provider Demographics
NPI:1770993107
Name:SHOGILEV, DANIEL J (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:SHOGILEV
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 1:2301 ERWIN ROAD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-684-8777
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-684-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2017-12-27
Deactivation Date:2014-12-09
Deactivation Code:
Reactivation Date:2015-02-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program