Provider Demographics
NPI:1063206027
Name:GUPTA, SUMA (APRN)
Entity type:Individual
Prefix:
First Name:SUMA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SUMA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:77 LAFAYETTE PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5437
Mailing Address - Country:US
Mailing Address - Phone:203-914-4843
Mailing Address - Fax:
Practice Address - Street 1:77 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5437
Practice Address - Country:US
Practice Address - Phone:203-863-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner