Healthcare Provider Details

I. General information

NPI: 1063206027
Provider Name (Legal Business Name): SUMA GUPTA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMA GUPTA RN

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 LAFAYETTE PL
GREENWICH CT
06830-5437
US

IV. Provider business mailing address

77 LAFAYETTE PL
GREENWICH CT
06830-5437
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3031
  • Fax:
Mailing address:
  • Phone: 203-914-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14627
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: