Healthcare Provider Details

I. General information

NPI: 1356903017
Provider Name (Legal Business Name): SUTANAYA PAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 HARRISON ST
SYRACUSE NY
13210-2695
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3265
  • Fax:
Mailing address:
  • Phone: 315-464-3165
  • Fax: 315-464-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number318981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: