Individual
MARY SHENOUDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1615 SW MAIN BLVD, LAKE CITY, FL 32025-1108
(386) 755-2785
(386) 755-1128
Mailing address
PO BOX 489, LAKE CITY, FL 32056-0489
(386) 755-2785
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01060074A
IN
207W00000X
Ophthalmology Physician
88852
OH
207W00000X
Ophthalmology Physician
Primary
ME165007
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2713460
—
OH
Enumeration date
12/14/2005
Last updated
12/14/2023
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