Healthcare Provider Details

I. General information

NPI: 1083354864
Provider Name (Legal Business Name): HARSHITA GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

V. Phone/Fax

Practice location:
  • Phone: 407-737-7010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A23980
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP05738
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: