Provider Demographics
NPI:1548615529
Name:SANNAKKI, SHEETAL (PT)
Entity Type:Individual
Prefix:
First Name:SHEETAL
Middle Name:
Last Name:SANNAKKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 TALISMAN ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1462
Mailing Address - Country:US
Mailing Address - Phone:818-620-4803
Mailing Address - Fax:
Practice Address - Street 1:1835 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4600
Practice Address - Country:US
Practice Address - Phone:310-287-3711
Practice Address - Fax:310-287-3717
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42628208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation