Provider Demographics
NPI:1750367686
Name:VYAS, SHARAD (MD)
Entity type:Individual
Prefix:
First Name:SHARAD
Middle Name:
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 1:2186 HARRIS AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4044
Mailing Address - Country:US
Mailing Address - Phone:321-725-8111
Mailing Address - Fax:321-984-0552
Practice Address - Street 1:2186 HARRIS AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4044
Practice Address - Country:US
Practice Address - Phone:321-725-8111
Practice Address - Fax:321-984-0552
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037766000Medicaid
FL037766000Medicaid