Healthcare Provider Details

I. General information

NPI: 1922265123
Provider Name (Legal Business Name): ANJALI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 NOCATEE VILLAGE DR
PONTE VEDRA FL
32081-6152
US

IV. Provider business mailing address

PO BOX 746636
ATLANTA GA
30374-6636
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-4243
  • Fax: 904-390-7415
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53015
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME156826
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101246997
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: