Provider Demographics
NPI:1265594691
Name:VAIDYA, VAISHALI MAHESH (PA-C)
Entity type:Individual
Prefix:MISS
First Name:VAISHALI
Middle Name:MAHESH
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 US HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4311
Mailing Address - Country:US
Mailing Address - Phone:830-798-1153
Mailing Address - Fax:830-798-1124
Practice Address - Street 1:1701 US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4311
Practice Address - Country:US
Practice Address - Phone:830-798-1153
Practice Address - Fax:830-798-1124
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 04120363AM0700X
NY010265363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ33299Medicare UPIN
TX8D1001Medicare ID - Type Unspecified