Provider Demographics
NPI:1457671182
Name:GUPTA, JYOTI RANI (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:RANI
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JYOTI
Other - Middle Name:RANI
Other - Last Name:DUGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1925 MIZELL AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4155
Mailing Address - Country:US
Mailing Address - Phone:407-629-4305
Mailing Address - Fax:407-740-5089
Practice Address - Street 1:1925 MIZELL AVE STE 302
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4155
Practice Address - Country:US
Practice Address - Phone:407-629-4305
Practice Address - Fax:407-740-5089
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109796207W00000X
FLME 109796207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003148905AMedicaid
FL003923300Medicaid
GA003148905AMedicaid