Provider Demographics
NPI:1114712064
Name:GUPTA, ASHWINI (MBBS)
Entity type:Individual
Prefix:MS
First Name:ASHWINI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS RD, STONY BROOK CHILDREN'S
Mailing Address - Street 2:HSC T11-040
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-2020
Mailing Address - Fax:631-444-2894
Practice Address - Street 1:101 NICOLLS RD, STONY BROOK CHILDREN'S
Practice Address - Street 2:HSC T11-040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-2020
Practice Address - Fax:631-444-2894
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program