Basic Information
| Provider Information | |||||||||
| NPI: | 1467424382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | SHAILESH | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6280 W SAMPLE RD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330673173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613223588 | ||||||||
| FaxNumber: | 7548125993 | ||||||||
| Practice Location | |||||||||
| Address1: | 6280 W SAMPLE RD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330673173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613223588 | ||||||||
| FaxNumber: | 7548125993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME81086 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.