Individual
DR. SHANU GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5 TAMPA GENERAL CIR # 750, TAMPA, FL 33606
(813) 844-3397
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME136934
FL
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
ME136934
FL
208M00000X
Hospitalist Physician
Primary
ME136934
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100798400
—
FL
01
—
ORLS2
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/14/2009
Last updated
04/26/2021
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