MEDICARE: DR. SHOBHA GUPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME36479	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306883038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOBHA GUPTA

Provider Business Mailing Address
First Line	:	3342 N.E. 34TH ST.
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6906
Country	:	US
Telephone Number	:	954-583-7287
Fax Number	:	954-583-0535

Provider Business Practice Location Address
First Line	:	3342 N.E. 34TH ST.
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6906
Country	:	US
Telephone Number	:	954-583-7287
Fax Number	:	954-583-0535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/11/2020

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Directions to “ DR. SHOBHA GUPTA ” Practice Location

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