Provider Demographics
NPI:1174821060
Name:SUKUMARAN, NIYATEE (PHD)
Entity Type:Individual
Prefix:
First Name:NIYATEE
Middle Name:
Last Name:SUKUMARAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR DEPT 304
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0304
Mailing Address - Country:US
Mailing Address - Phone:858-534-9057
Mailing Address - Fax:858-534-2628
Practice Address - Street 1:9500 GILMAN DR DEPT 304
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0304
Practice Address - Country:US
Practice Address - Phone:858-534-9057
Practice Address - Fax:858-534-2628
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29467103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist