Healthcare Provider Details

I. General information

NPI: 1417876459
Provider Name (Legal Business Name): TANEESHA GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

230 ARBOR COMMONS CIR APT NO05-304
MEMPHIS TN
38120-2698
US

V. Phone/Fax

Practice location:
  • Phone: 443-763-7975
  • Fax:
Mailing address:
  • Phone: 443-763-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: