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General NPI Number Information
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NPI Number | 1699937953
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Entity Type | Individual
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Provider Name | SREELATHA R. PULAKHANDAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 152 GATEWAY DR
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City | BILOXI
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State | MS
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Zip | 39531-4409
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Country | US
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Telephone | 228-388-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 2829 4TH AVENUE
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City | LAKE CHARLES
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State | LA
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Zip | 70601
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Country | US
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Telephone | 337-477-7091
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Fax | 337-474-4552
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 201314
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 29848
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License Number State | MS
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