Provider Demographics
NPI:1790917805
Name:BALASURIYA, LILANTHI (MD)
Entity Type:Individual
Prefix:MISS
First Name:LILANTHI
Middle Name:
Last Name:BALASURIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YALE UNIVERSITY DEPARTMENT OF PSYCHIATRY, 300 GEORGE ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-785-2095
Mailing Address - Fax:
Practice Address - Street 1:YALE UNIVERSITY DEPARTMENT OF PSYCHIATRY, 300 GEORGE ST
Practice Address - Street 2:SUITE 901
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-785-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT617012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program