Healthcare Provider Details

I. General information

NPI: 1750367686
Provider Name (Legal Business Name): SHARAD VYAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 HARRIS AVE NE
PALM BAY FL
32905-4044
US

IV. Provider business mailing address

2186 HARRIS AVE NE
PALM BAY FL
32905-4044
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-8111
  • Fax: 321-984-0552
Mailing address:
  • Phone: 321-725-8111
  • Fax: 321-984-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME33726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: