Healthcare Provider Details

I. General information

NPI: 1235631599
Provider Name (Legal Business Name): SANKET VYAS, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MONTGOMERY ST # F19
SAN FRANCISCO CA
94104-1856
US

IV. Provider business mailing address

2222 STONEHENGE LN
LEWISVILLE TX
75056-5559
US

V. Phone/Fax

Practice location:
  • Phone: 888-875-3383
  • Fax:
Mailing address:
  • Phone: 888-875-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SANKET VYAS
Title or Position: OWNER
Credential: MD
Phone: 888-875-3383