Provider Demographics
NPI:1073662789
Name:VYAS, SHAYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYAN
Middle Name:
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6718
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S ORANGE AVE STE 100
Practice Address - Street 2:NEMOURS CHILDRENS CLINIC
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-650-7715
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME105218208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics