MEDICARE: KRUPA GANDHI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363AM0700X	Medical Physician Assistant	PA9120025	FL

General Provider Information

NPI Number	:	1174245922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRUPA GANDHI PA-C

Provider Business Mailing Address
First Line	:	PO BOX 7410884
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0884
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	1350 S NOVA RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5812
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	12/05/2025

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Directions to “ KRUPA GANDHI PA-C” Practice Location

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