Provider Demographics
NPI:1497580237
Name:GUPTA, NIDHI MAHENDRA (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:MAHENDRA
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:DR
Other - First Name:NIDHI
Other - Middle Name:
Other - Last Name:MAHENDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, CCC-SLP
Mailing Address - Street 1:1131 ROSEPINE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6628
Mailing Address - Country:US
Mailing Address - Phone:510-396-1098
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY HOSPITAL 2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:510-396-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12021718235Z00000X
CASP12925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist