Provider Demographics
NPI:1508979311
Name:GUPTA, SUNIL (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2709
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-2709
Mailing Address - Country:US
Mailing Address - Phone:813-788-1400
Mailing Address - Fax:813-788-7691
Practice Address - Street 1:38035 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540
Practice Address - Country:US
Practice Address - Phone:813-788-1400
Practice Address - Fax:813-788-7691
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78413207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257622800Medicaid
E2939AMedicare PIN
FL257622800Medicaid