Healthcare Provider Details

I. General information

NPI: 1881852853
Provider Name (Legal Business Name): ANJALI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 N SPRING GARDEN AVE
DELAND FL
32720-2560
US

IV. Provider business mailing address

PO BOX 9671
DAYTONA BEACH FL
32120-9671
US

V. Phone/Fax

Practice location:
  • Phone: 386-736-1948
  • Fax: 386-736-2784
Mailing address:
  • Phone: 386-676-7130
  • Fax: 386-676-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME87066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: