Provider Demographics
NPI:1245487743
Name:PURUSHOTHAMAN, PRITI (MD)
Entity type:Individual
Prefix:DR
First Name:PRITI
Middle Name:
Last Name:PURUSHOTHAMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 AVALON PARK EAST BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4900
Mailing Address - Country:US
Mailing Address - Phone:407-488-7266
Mailing Address - Fax:
Practice Address - Street 1:3801 AVALON PARK EAST BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4900
Practice Address - Country:US
Practice Address - Phone:407-488-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1427762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry