Shenouda, Mary

Shenouda, Mary is an individual health care provider with primary practice located at 1615 Sw Main Blvd , Lake City FL 32025-1108. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Shenouda, Mary can be contacted via phone (386) 755-2785.

Contact Information

Primary practice address
1615 Sw Main Blvd Lake City FL 32025-1108
Phone: (386) 755-2785
Fax: (386) 755-1128
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 01060074A Indiana
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 88852 Ohio
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X ME165007 Florida

Profile Details

NPI number 1104801976
LBN Legal business name Shenouda, Mary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Dec 14th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104801976 NPPES
Ohio MEDICAID 2713460

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