Healthcare Provider Details

I. General information

NPI: 1043088974
Provider Name (Legal Business Name): DR. CHAMILA NIROSHANA RUPASINGHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 NUTMEG DR STE 303
TRUMBULL CT
06611-5495
US

IV. Provider business mailing address

4367 MADISON AVE
TRUMBULL CT
06611-2717
US

V. Phone/Fax

Practice location:
  • Phone: 475-208-1621
  • Fax: 888-503-3516
Mailing address:
  • Phone: 313-657-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberRUPAC1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: