Healthcare Provider Details

I. General information

NPI: 1326386996
Provider Name (Legal Business Name): TINA ANNE MARIE SHENOUDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 GULFGATE CENTER MALL
HOUSTON TX
77087-3023
US

IV. Provider business mailing address

6416 OLD WINTER GARDEN RD
ORLANDO FL
32835-1348
US

V. Phone/Fax

Practice location:
  • Phone: 281-846-7209
  • Fax: 833-845-2871
Mailing address:
  • Phone: 407-751-7288
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101252936
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS1268
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 114649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: