Healthcare Provider Details

I. General information

NPI: 1134475569
Provider Name (Legal Business Name): ARCHANA ANIL GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD N STE 118
BOCA RATON FL
33428-1703
US

IV. Provider business mailing address

9980 CENTRAL PARK BLVD N STE 118
BOCA RATON FL
33428-1703
US

V. Phone/Fax

Practice location:
  • Phone: 561-931-2655
  • Fax: 561-931-2657
Mailing address:
  • Phone: 561-931-2655
  • Fax: 561-931-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME130980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: