Provider Demographics
NPI:1851312326
Name:VYAS, SAHANA (MD)
Entity Type:Individual
Prefix:
First Name:SAHANA
Middle Name:
Last Name:VYAS
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 1:8679 CONNECTICUT STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-769-9022
Mailing Address - Fax:219-769-9022
Practice Address - Street 1:8679 CONNECTICUT STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-769-9022
Practice Address - Fax:219-769-9022
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071628A207W00000X
IL036131211207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN496710OtherMEDICARE
IL660093003OtherMEDICARE LICENSE
IN201135120Medicaid
IL036131211Medicaid
IL036131211OtherILLINOIS LICENSE
IN01071628AOtherINDIANA LICENSE