Healthcare Provider Details

I. General information

NPI: 1033737200
Provider Name (Legal Business Name): NEENU SUKUMARAN MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 LITCHFIELD ST STE 101
TORRINGTON CT
06790-6669
US

IV. Provider business mailing address

538 LITCHFIELD ST STE 101
TORRINGTON CT
06790-6669
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-1790
  • Fax: 860-496-0251
Mailing address:
  • Phone: 860-496-1790
  • Fax: 860-496-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number82304
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: