Healthcare Provider Details

I. General information

NPI: 1346232246
Provider Name (Legal Business Name): HANY S SHENOUDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S RAVENEL ST STE 300
FLORENCE SC
29506-2621
US

IV. Provider business mailing address

101 S RAVENEL ST STE 300
FLORENCE SC
29506-2621
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7490
  • Fax: 843-777-7480
Mailing address:
  • Phone: 843-777-7490
  • Fax: 843-777-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number22890
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD90443
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number17595
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: