Provider Demographics
NPI:1134104045
Name:SHENOUDA, TERESA A (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:A
Last Name:SHENOUDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 HEALTHY WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7961
Mailing Address - Country:US
Mailing Address - Phone:757-932-5393
Mailing Address - Fax:757-938-5121
Practice Address - Street 1:828 HEALTHY WAY STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7961
Practice Address - Country:US
Practice Address - Phone:757-932-5393
Practice Address - Fax:757-938-5121
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235363207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I12013Medicare UPIN
022445B11Medicare PIN