Basic Information
| Provider Information | |||||||||
| NPI: | 1326386996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHENOUDA | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | ANNE MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6416 OLD WINTER GARDEN RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328351348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077517288 | ||||||||
| FaxNumber: | 4077700661 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 GULFGATE CENTER MALL | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770873023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818467209 | ||||||||
| FaxNumber: | 8338452871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101252936 | VA | N | Other Service Providers | Specialist | 207Q00000X | S1268 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 174400000X | ME 114649 | FL | N | Other Service Providers | Specialist |
No ID Information.