Healthcare Provider Details

I. General information

NPI: 1275687261
Provider Name (Legal Business Name): AMIT UPADHIAYA DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE RD STE 305
DEERFIELD BEACH FL
33064-3547
US

IV. Provider business mailing address

1 W SAMPLE RD
DEERFIELD BEACH FL
33064-3547
US

V. Phone/Fax

Practice location:
  • Phone: 954-366-6335
  • Fax: 954-366-6028
Mailing address:
  • Phone: 954-366-6335
  • Fax: 954-366-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number059136
License Number StateFL

VIII. Authorized Official

Name: DR. AMIT UPADHIAYA
Title or Position: PRES
Credential: DO
Phone: 954-782-3170