Healthcare Provider Details

I. General information

NPI: 1376428771
Provider Name (Legal Business Name): MR. MINA SHENOUDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DRIVE
STRATFORD NJ
08084-1501
US

IV. Provider business mailing address

19 HOLLIS RD
EAST BRUNSWICK NJ
08816-2756
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7050
  • Fax:
Mailing address:
  • Phone: 848-391-2937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: