Provider Demographics
NPI:1043892896
Name:SHENOUDA, MAGDOLIN MISHEL SAMY SAAD (PT, DPT, PHD)
Entity Type:Individual
Prefix:
First Name:MAGDOLIN
Middle Name:MISHEL SAMY SAAD
Last Name:SHENOUDA
Suffix:
Gender:F
Credentials:PT, DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 PARKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1603
Mailing Address - Country:US
Mailing Address - Phone:120-138-0638
Mailing Address - Fax:
Practice Address - Street 1:317 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1400
Practice Address - Country:US
Practice Address - Phone:201-380-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01735200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist