Provider Demographics
NPI:1326234493
Name:VYAS, BAVNA BAGYALAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:BAVNA
Middle Name:BAGYALAKSHMI
Last Name:VYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BAVNA
Other - Middle Name:BAGYALAKSHMI
Other - Last Name:GANGADHARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10000 BAY PINES BLVD
Mailing Address - Street 2:DEPARTMENT OF GERIATRICS AND EXTENDED CARE
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33744-8200
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:DEPARTMENT OF GERIATRICS AND EXTENDED CARE
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-8200
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110439207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine