Shenouda Corp

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

SHENOUDA CORP

Doing business as

Michael Mitry, DPM

Practice address

1410 Highland Ave Ste 204
Needham, MA 02492

Phone

(781) 444-4044

Fax

(781) 444-5044

NPI assigned

Mar 2, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Mitry, DPMNPI 1700193406

Title

Podiatrist

Phone

(508) 361-0078

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Michael Mitry, DPM Doing business as

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Mitry, DPM

  • Foot & Ankle Surgery Podiatrist
  • Needham, MA
  • NPI 1700193406
  Medicare reassignment Care Compare group NPD Authorized official
• Christopher David Karter, DPM

  • Foot & Ankle Surgery Podiatrist
  • Needham, MA
  • NPI 1861875031
  Medicare reassignment Care Compare group NPD
• Michael Moharan, DPM

  • Foot & Ankle Surgery Podiatrist
  • North Andover, MA
  • NPI 1700157039
  NPD (past)
• Timothy J Ryan

  • Podiatrist
  • Medfield, MA
  • NPI 1205826393
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543276800000",
    "number": "1386036275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 HIGHLAND AVE STE 204",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024922617",
            "telephone_number": "781-444-4044",
            "fax_number": "781-444-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 HIGHLAND AVE STE 204",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "02492",
            "telephone_number": "781-444-4044",
            "fax_number": "781-444-5044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 Dedham Ave",
            "address_purpose": "LOCATION",
            "city": "Needham",
            "state": "MA",
            "postal_code": "024923061",
            "country_code": "US",
            "telephone_number": "508-361-0078",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 East St Ste 6",
            "address_purpose": "LOCATION",
            "city": "Hanover",
            "state": "MA",
            "postal_code": "023391638",
            "country_code": "US",
            "telephone_number": "781-826-1150",
            "fax_number": "781-826-6052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "31 Pine St Ste 206",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "MA",
            "postal_code": "020561680",
            "country_code": "US",
            "telephone_number": "781-826-6110",
            "fax_number": "781-826-6118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHENOUDA CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-02",
        "last_updated": "2018-11-27",
        "status": "A",
        "authorized_official_last_name": "MITRY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "508-361-0078",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110109398C",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael Mitry, DPM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Michael Mitry, DPM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Shaw, LICSW
• Sakle Shaw
• Jacqueline A. Shea
• Erin Michelle Sheehan
• Yangqian Shen
• Michelle Sheriff
• Nathaniel Thomas Shipley
• Susan Lynn Shoobe, PSY.D.
• Eleanor G Shore, M.D.
• Jon Shusterman, DMD

• Foot & Ankle Surgery Podiatrist in Needham, MA
• Providers in Needham, MA by specialty
• Foot & Ankle Surgery Podiatrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.