Provider Demographics
NPI:1780676056
Name:VYAS, SHEFALI (MD)
Entity type:Individual
Prefix:
First Name:SHEFALI
Middle Name:
Last Name:VYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 OLD SHORT HILLS RD STE 505
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:973-322-6767
Mailing Address - Fax:973-322-6780
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 505
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-322-6767
Practice Address - Fax:973-322-6780
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2260922080P0210X
NJMA0800952080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02132025Medicaid
NJ0101427Medicaid
NY02132025Medicaid
NJ0101427Medicaid