Provider Demographics
NPI:1326386996
Name:SHENOUDA, TINA ANNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:ANNE MARIE
Last Name:SHENOUDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6416 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1348
Mailing Address - Country:US
Mailing Address - Phone:407-751-7288
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:545 GULFGATE CENTER MALL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3023
Practice Address - Country:US
Practice Address - Phone:281-846-7209
Practice Address - Fax:833-845-2871
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101252936174400000X
TXS1268207Q00000X
FLME 114649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist