Provider Demographics
NPI:1417052309
Name:VYAS, VEDA R (MD)
Entity Type:Individual
Prefix:DR
First Name:VEDA
Middle Name:R
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LEE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2162
Mailing Address - Country:US
Mailing Address - Phone:407-740-0383
Mailing Address - Fax:407-740-0470
Practice Address - Street 1:1801 LEE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2162
Practice Address - Country:US
Practice Address - Phone:407-740-0383
Practice Address - Fax:407-740-0470
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00644872084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373789600Medicaid
FL373789600Medicaid
FL23740AMedicare ID - Type Unspecified