Provider Demographics
NPI:1922039189
Name:SHOEMAKER, DAVID GARDNER (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARDNER
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 TOXEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:916-492-6311
Mailing Address - Fax:866-611-0706
Practice Address - Street 1:100 EUROPA DR STE 403
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2389
Practice Address - Country:US
Practice Address - Phone:916-492-6311
Practice Address - Fax:866-611-0706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15369103T00000X
NC5593103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist