Healthcare Provider Details

I. General information

NPI: 1871768291
Provider Name (Legal Business Name): KAVITA GUPTA-SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAVITA GUPTA MD

II. Dates (important events)

Enumeration Date: 04/26/2008
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 HEACOCK RD STE 200
YARDLEY PA
19067-6346
US

IV. Provider business mailing address

295 BUCK RD STE 106
HOLLAND PA
18966-1748
US

V. Phone/Fax

Practice location:
  • Phone: 215-493-6519
  • Fax: 215-493-6704
Mailing address:
  • Phone: 215-322-1919
  • Fax: 215-322-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08390800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD448419
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243302
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: