Provider Demographics
NPI:1588771810
Name:SHENOUDA-AWAD, NANCY Y (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:Y
Last Name:SHENOUDA-AWAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 RIVERSIDE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4813
Mailing Address - Country:US
Mailing Address - Phone:203-557-4275
Mailing Address - Fax:203-557-4275
Practice Address - Street 1:VA HUDSON VALLEY -FDR CAMPUS,
Practice Address - Street 2:OPTOMETRY SERVICE (620-123)
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007049-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist