Healthcare Provider Details

I. General information

NPI: 1477363232
Provider Name (Legal Business Name): NIKKI LYNN GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 BERKSHIRE BLVD STE 100
READING PA
19610-1222
US

IV. Provider business mailing address

26 SELTZER AVE
WOMELSDORF PA
19567-1315
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax:
Mailing address:
  • Phone: 610-955-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: