Provider Demographics
NPI:1992850184
Name:VYAS, SHYAM A (MD)
Entity Type:Individual
Prefix:MR
First Name:SHYAM
Middle Name:A
Last Name:VYAS
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 1:3516 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-560-0818
Mailing Address - Fax:936-560-5610
Practice Address - Street 1:3516 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-560-0818
Practice Address - Fax:936-560-5610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL47902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158515001Medicaid
TX158515001Medicaid
TX00985HMedicare PIN
$$$$$$$$$Medicare PIN