Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104001672 | VA |
NPI | 1114927217 |
---|---|
Provider Name | Dr. Daniel A Shaye |
First Address | Williamsburg, VA 23185-3381 |
Second Address | Williamsburg, VA 23185-3381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 21/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15529P62 | MEDICARE INDIVIDUAL PTAN (01) | VA |
C05162 | MEDICARE GROUP PTAN (01) | VA |
U62594 | (02) |