Provider Demographics
NPI:1356453880
Name:VAKIL, VIDYA SHAILESH (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:SHAILESH
Last Name:VAKIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 CONOVER RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3228
Mailing Address - Country:US
Mailing Address - Phone:609-275-0729
Mailing Address - Fax:609-275-3875
Practice Address - Street 1:666 PLAINSBORO RD STE 1H BLDG 100
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3003
Practice Address - Country:US
Practice Address - Phone:609-275-0729
Practice Address - Fax:609-275-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0412562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12-020Medicaid