Healthcare Provider Details

I. General information

NPI: 1831558329
Provider Name (Legal Business Name): SHELLY GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 CLARK AVE
DUBLIN CA
94568-3036
US

IV. Provider business mailing address

2345 COUNTRY HILLS DR
ANTIOCH CA
94509-7319
US

V. Phone/Fax

Practice location:
  • Phone: 925-875-1677
  • Fax: 925-875-0826
Mailing address:
  • Phone: 925-418-0282
  • Fax: 925-978-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA151829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: