Provider Demographics
NPI:1669485819
Name:KURUKULASURIYA, RANJANI (MD)
Entity Type:Individual
Prefix:
First Name:RANJANI
Middle Name:
Last Name:KURUKULASURIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RANJANI
Other - Middle Name:
Other - Last Name:KURUKULASURIYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:995 DAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1722
Mailing Address - Country:US
Mailing Address - Phone:860-731-5522
Mailing Address - Fax:860-731-5536
Practice Address - Street 1:693 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2489
Practice Address - Country:US
Practice Address - Phone:860-243-6584
Practice Address - Fax:860-243-6591
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0172572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2190127OtherCIGNA
2190127OtherCIGNA
F21663Medicare UPIN