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General NPI Number Information
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NPI Number | 1487668463
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Entity Type | Individual
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Provider Name | DR. SHEILA R GUPTA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 345 CLYDE MORRIS BLVD SUITE 390
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City | ORMOND BEACH
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State | FL
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Zip | 32174-3111
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Country | US
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Telephone | 386-673-0075
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Fax | 386-673-0049
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Provider Business Mailing Address
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Address Line | 345 CLYDE MORRIS BLVD SUITE 390
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City | ORMOND BEACH
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State | FL
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Zip | 32174-3111
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Country | US
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Telephone | 386-673-0075
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Fax | 386-673-0049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME98147
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License Number State | FL
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