Provider Demographics
NPI:1558308551
Name:GUPTA, DEVANSHI (MD)
Entity type:Individual
Prefix:DR
First Name:DEVANSHI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N ALLEN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2581
Mailing Address - Country:US
Mailing Address - Phone:972-727-7070
Mailing Address - Fax:972-727-7080
Practice Address - Street 1:400 N ALLEN DR STE 105
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-727-7070
Practice Address - Fax:972-727-7080
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS181802084N0400X
TXN00682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08832577Medicaid
MS08832577Medicaid
TX313590YKP5Medicare PIN
I16695Medicare UPIN