Healthcare Provider Details

I. General information

NPI: 1851748438
Provider Name (Legal Business Name): GILLIAN V KUPAKUWANA-SUK M.D., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 YORK ST YNHH DEPT OF MEDICINE, LMP 1092
NEW HAVEN CT
06510-3221
US

IV. Provider business mailing address

DEPT. OF MEDICINE MEDICAL SERVICE GROUP 750 E. ADAMS ST.
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-5555
  • Fax:
Mailing address:
  • Phone: 315-464-8200
  • Fax: 315-464-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number298769
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number298769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: