Provider Demographics
NPI:1902095938
Name:GUPTA, SHAILA BHATT (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAILA
Middle Name:BHATT
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHAILA
Other - Middle Name:BHARAT
Other - Last Name:BHATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-2995
Mailing Address - Fax:
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-836-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003548A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology