Provider Demographics
NPI:1598995185
Name:PRIYADARSHI, VIKASH (MD)
Entity Type:Individual
Prefix:
First Name:VIKASH
Middle Name:
Last Name:PRIYADARSHI
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:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-462-4001
Mailing Address - Fax:321-622-6400
Practice Address - Street 1:336 COGAN DR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6869
Practice Address - Country:US
Practice Address - Phone:321-460-4001
Practice Address - Fax:321-622-6400
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111767207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine