Provider Demographics
NPI:1861183246
Name:SHOROUK, ELSHAFEI (MD)
Entity type:Individual
Prefix:
First Name:ELSHAFEI
Middle Name:
Last Name:SHOROUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 N MAJOR DR ., APT 1412
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713
Mailing Address - Country:US
Mailing Address - Phone:409-444-7139
Mailing Address - Fax:
Practice Address - Street 1:3080 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701
Practice Address - Country:US
Practice Address - Phone:409-212-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-01-23
Deactivation Date:2023-12-21
Deactivation Code:
Reactivation Date:2024-01-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program