Provider Demographics
NPI:1639924079
Name:ENNOLIKARA, SNEHA RAO (APCC)
Entity type:Individual
Prefix:
First Name:SNEHA
Middle Name:RAO
Last Name:ENNOLIKARA
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:SNEHA
Other - Middle Name:RAGHUNATHA
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 N 1ST ST UNIT 93
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95103-3004
Mailing Address - Country:US
Mailing Address - Phone:626-327-7339
Mailing Address - Fax:
Practice Address - Street 1:425 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1936
Practice Address - Country:US
Practice Address - Phone:408-318-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16228101Y00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor