Provider Demographics
NPI:1356794937
Name:DASGUPTA, SHRUTI (LP,PHD)
Entity type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:DASGUPTA
Suffix:
Gender:F
Credentials:LP,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 DAYTON AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6631
Mailing Address - Country:US
Mailing Address - Phone:612-436-4840
Mailing Address - Fax:612-436-2604
Practice Address - Street 1:649 DAYTON AVE.
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6631
Practice Address - Country:US
Practice Address - Phone:612-436-4840
Practice Address - Fax:612-436-2604
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2012936103TC0700X
390200000X
MNLP6919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program