Provider Demographics
NPI:1740702471
Name:GUPTE, SHAMITA TEJAS
Entity type:Individual
Prefix:MRS
First Name:SHAMITA
Middle Name:TEJAS
Last Name:GUPTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHAMITA
Other - Middle Name:SHIVRAJ
Other - Last Name:RANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 E 24TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3927
Mailing Address - Country:US
Mailing Address - Phone:612-223-8879
Mailing Address - Fax:
Practice Address - Street 1:1305 E 24TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3927
Practice Address - Country:US
Practice Address - Phone:612-223-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist