Provider Demographics
NPI:1922190859
Name:VYAS, DAKSHA C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAKSHA
Middle Name:C
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 1:200 E. 89TH AVE.
Mailing Address - Street 2:SUITE 3 - B
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7319
Mailing Address - Country:US
Mailing Address - Phone:219-769-7861
Mailing Address - Fax:219-769-6281
Practice Address - Street 1:200 E. 89TH AVE.
Practice Address - Street 2:SUITE 3 - B
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7319
Practice Address - Country:US
Practice Address - Phone:219-769-7861
Practice Address - Fax:219-769-6281
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010326922084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100169820Medicaid
130001339OtherRAILROAD MEDICARE
130001339OtherRAILROAD MEDICARE
IN100169820Medicaid