Provider Demographics
NPI:1205991189
Name:VYAS, SEJAL K (PHD)
Entity type:Individual
Prefix:DR
First Name:SEJAL
Middle Name:K
Last Name:VYAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 95TH ST
Mailing Address - Street 2:APARTMENT 27A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4000
Mailing Address - Country:US
Mailing Address - Phone:917-699-3244
Mailing Address - Fax:
Practice Address - Street 1:49 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2813
Practice Address - Country:US
Practice Address - Phone:917-539-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015699103G00000X, 103TC0700X
CT002667103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015699OtherLICENSE #
CT002667OtherLICENSE #