Provider Demographics
NPI:1649469008
Name:VEDA R VYAS MD LLC
Entity type:Organization
Organization Name:VEDA R VYAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VEDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-740-0383
Mailing Address - Street 1:1801 LEE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2163
Mailing Address - Country:US
Mailing Address - Phone:407-740-0383
Mailing Address - Fax:
Practice Address - Street 1:1801 LEE RD STE 220
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2163
Practice Address - Country:US
Practice Address - Phone:407-740-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373789600Medicaid
FL23740AMedicare PIN
FLE54989Medicare UPIN
FL16494690008Medicare PIN