Provider Demographics
NPI:1942654207
Name:GUPTA, SHRUTI (DO)
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:4200 HOUMA BLVD FL 7
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:504-503-4331
Practice Address - Fax:504-503-4341
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2025-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS34225207Q00000X
LA307423207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine