MEDICARE: DR. TERESA A SHENOUDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0101235363	VA

General Provider Information

NPI Number	:	1134104045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA A SHENOUDA M.D.

Provider Business Mailing Address
First Line	:	828 HEALTHY WAY STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7961
Country	:	US
Telephone Number	:	757-932-5393
Fax Number	:	757-938-5121

Provider Business Practice Location Address
First Line	:	828 HEALTHY WAY STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-7961
Country	:	US
Telephone Number	:	757-932-5393
Fax Number	:	757-938-5121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	12/04/2019

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