Provider Demographics
NPI:1689289936
Name:VYAS, DAMINI SHARAD
Entity Type:Individual
Prefix:MS
First Name:DAMINI
Middle Name:SHARAD
Last Name:VYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 SAN BRUNO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-2009
Mailing Address - Country:US
Mailing Address - Phone:415-770-8590
Mailing Address - Fax:
Practice Address - Street 1:2712 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1117
Practice Address - Country:US
Practice Address - Phone:510-548-8283
Practice Address - Fax:510-548-2938
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61183499101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty