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General NPI Number Information
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NPI Number | 1790170561
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Entity Type | Individual
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Provider Name | SHIVANI RANI GUPTA
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Gender | Female
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 215 W BOWERY ST FL 6
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City | AKRON
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State | OH
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Zip | 44308-1069
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Country | US
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Telephone | 330-543-7397
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Fax |
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Provider Business Mailing Address
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Address Line | 11819 DORENA CIR NW
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City | UNIONTOWN
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State | OH
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Zip | 44685-6674
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Country | US
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Telephone | 843-371-4659
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Fax |
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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 | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 34.012646
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License Number State | OH
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