Provider Demographics
NPI:1396410007
Name:SANI, ANNITA ALYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNITA
Middle Name:ALYCE
Last Name:SANI
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 1:19005 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2745
Mailing Address - Country:US
Mailing Address - Phone:734-968-0594
Mailing Address - Fax:
Practice Address - Street 1:19005 MOTT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2745
Practice Address - Country:US
Practice Address - Phone:734-968-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical