Provider Demographics
NPI:1003207648
Name:PULIKKOTIL, SANITHA
Entity Type:Individual
Prefix:MRS
First Name:SANITHA
Middle Name:
Last Name:PULIKKOTIL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SANITHA
Other - Middle Name:
Other - Last Name:POOTHAKARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2845 TALL OAKS CT
Mailing Address - Street 2:APT. 23
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 N GROESBECK HWY
Practice Address - Street 2:UNIT 175-F
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1562
Practice Address - Country:US
Practice Address - Phone:586-627-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional