Provider Demographics
NPI:1538693544
Name:SHENOUDA, MINA K (MD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:K
Last Name:SHENOUDA
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 1:1104 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742
Mailing Address - Country:US
Mailing Address - Phone:732-653-1000
Mailing Address - Fax:732-714-0188
Practice Address - Street 1:1104 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742
Practice Address - Country:US
Practice Address - Phone:732-714-0070
Practice Address - Fax:732-714-0188
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171100000X
NJ25MA11094400208100000X, 2081P2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No171100000XOther Service ProvidersAcupuncturist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program