Provider Demographics
NPI:1184818866
Name:SHNOUDA, JOSEPH F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:F
Last Name:SHNOUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4880
Mailing Address - Country:US
Mailing Address - Phone:813-443-1448
Mailing Address - Fax:813-443-1448
Practice Address - Street 1:4691 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558
Practice Address - Country:US
Practice Address - Phone:813-443-1448
Practice Address - Fax:813-443-1448
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245909207R00000X
FLME104671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02941720Medicaid
FLME104671OtherFLORIDA MEDICAL LICENSE