Provider Demographics
NPI:1487668463
Name:GUPTA, SHEILA R
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:R
Last Name:GUPTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3111
Mailing Address - Country:US
Mailing Address - Phone:386-673-0075
Mailing Address - Fax:386-673-0049
Practice Address - Street 1:345 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 390
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3111
Practice Address - Country:US
Practice Address - Phone:386-673-0075
Practice Address - Fax:386-673-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98147207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AH515ZMedicare PIN
FLAH515YMedicare PIN