Provider Demographics
NPI:1356485403
Name:GUPTE, AMEETA SHAILESH (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:AMEETA
Middle Name:SHAILESH
Last Name:GUPTE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-3111
Mailing Address - Country:US
Mailing Address - Phone:908-754-8129
Mailing Address - Fax:
Practice Address - Street 1:310 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-3111
Practice Address - Country:US
Practice Address - Phone:908-754-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ924870133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered