Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME105218 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME105218 | FL |
NPI | 1073662789 |
---|---|
Provider Name | Dr. Shayan Vyas |
First Address | Rockland, DE 19732-0191 |
Second Address | Orlando, FL 32806-2946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 27/11/2012 |