Provider Demographics
NPI:1760762033
Name:VAKSHA, VEDANT (MD)
Entity Type:Individual
Prefix:
First Name:VEDANT
Middle Name:
Last Name:VAKSHA
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 1:2500 NESCONSET HWY BLDG 10D
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2553
Mailing Address - Country:US
Mailing Address - Phone:631-981-2663
Mailing Address - Fax:212-203-9223
Practice Address - Street 1:2500 NESCONSET HWY BLDG 10D
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2553
Practice Address - Country:US
Practice Address - Phone:631-981-2663
Practice Address - Fax:212-203-9223
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003891207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery