Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 226092 | NY |
Y | 2080P0210X | Pediatric Nephrologist | MA080095 | NJ |
NPI | 1780676056 |
---|---|
Provider Name | Shefali Vyas |
First Address | West Orange, NJ 07052-1023 |
Second Address | West Orange, NJ 07052-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 06/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101427 | (05) | NJ |
02132025 | (05) | NY |
H29953 | (02) | NY |