Provider Demographics
NPI:1750878609
Name:SHAFIEK, MENA SHOKRY (DPM)
Entity type:Individual
Prefix:
First Name:MENA
Middle Name:SHOKRY
Last Name:SHAFIEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 WYNDHAM RIDGE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6182
Mailing Address - Country:US
Mailing Address - Phone:614-256-8202
Mailing Address - Fax:
Practice Address - Street 1:1920 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2303
Practice Address - Country:US
Practice Address - Phone:740-344-8286
Practice Address - Fax:740-522-0094
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36004024213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0447311Medicaid