Healthcare Provider Details

I. General information

NPI: 1063500353
Provider Name (Legal Business Name): SANDEEP GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

IV. Provider business mailing address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

V. Phone/Fax

Practice location:
  • Phone: 281-484-9369
  • Fax: 281-484-1843
Mailing address:
  • Phone: 281-484-9369
  • Fax: 281-484-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberJ8256
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberJ8256
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: