Provider Demographics
NPI:1063031409
Name:SHALINI GUPTA MD INC
Entity Type:Organization
Organization Name:SHALINI GUPTA MD INC
Other - Org Name:MOKSHA DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-289-5965
Mailing Address - Street 1:9505 MONTGOMERY ROAD
Mailing Address - Street 2:STE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7248
Mailing Address - Country:US
Mailing Address - Phone:513-985-9885
Mailing Address - Fax:
Practice Address - Street 1:9505 MONTGOMERY RD STE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7248
Practice Address - Country:US
Practice Address - Phone:513-985-9885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty