Provider Demographics
NPI:1376992412
Name:SANYAL, SUDEEPA (RPH)
Entity Type:Individual
Prefix:
First Name:SUDEEPA
Middle Name:
Last Name:SANYAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1030
Mailing Address - Country:US
Mailing Address - Phone:203-448-1030
Mailing Address - Fax:
Practice Address - Street 1:7 STONY HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1030
Practice Address - Country:US
Practice Address - Phone:203-448-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist