Healthcare Provider Details

I. General information

NPI: 1710392345
Provider Name (Legal Business Name): MINA SHENOUDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

IV. Provider business mailing address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3804
US

V. Phone/Fax

Practice location:
  • Phone: 130-439-9661
  • Fax: 304-399-6621
Mailing address:
  • Phone: 304-399-6610
  • Fax: 304-399-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME177554
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME177554
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number29491
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: