Provider Demographics
NPI:1366697393
Name:BOURY, SHEENA (MD)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:BOURY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 DIXIE HWY STE 970
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2791
Mailing Address - Country:US
Mailing Address - Phone:859-320-9300
Mailing Address - Fax:859-320-9301
Practice Address - Street 1:1717 DIXIE HWY STE 970
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2791
Practice Address - Country:US
Practice Address - Phone:859-320-9300
Practice Address - Fax:859-320-9301
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK032510Medicare PIN