Provider Demographics
NPI:1043088974
Name:RUPASINGHE, CHAMILA NIROSHANA
Entity Type:Individual
Prefix:DR
First Name:CHAMILA
Middle Name:NIROSHANA
Last Name:RUPASINGHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4367 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2717
Mailing Address - Country:US
Mailing Address - Phone:313-657-7496
Mailing Address - Fax:
Practice Address - Street 1:35 NUTMEG DR STE 303
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5495
Practice Address - Country:US
Practice Address - Phone:475-208-1621
Practice Address - Fax:888-503-3516
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRUPAC1247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician