Provider Demographics
NPI:1982684767
Name:SHENOUDA, MAGDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:L
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 1:1729 BELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3933
Mailing Address - Country:US
Mailing Address - Phone:732-775-4138
Mailing Address - Fax:732-775-4158
Practice Address - Street 1:1729 BELMAR BLVD
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3933
Practice Address - Country:US
Practice Address - Phone:732-775-4138
Practice Address - Fax:732-775-4158
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06112300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty