Healthcare Provider Details

I. General information

NPI: 1023509502
Provider Name (Legal Business Name): SHIVALI GUPTA DO, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

IV. Provider business mailing address

1604 BLOSSOM HILL RD STE 10
SAN JOSE CA
95124-6350
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-8833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number20A24271
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A24271
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOP61408334
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberOP61408334
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: