Healthcare Provider Details

I. General information

NPI: 1356453880
Provider Name (Legal Business Name): VIDYA SHAILESH VAKIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 PLAINSBORO RD STE 1H BLDG 100
PLAINSBORO NJ
08536-3003
US

IV. Provider business mailing address

87 CONOVER RD
WEST WINDSOR NJ
08550-3228
US

V. Phone/Fax

Practice location:
  • Phone: 609-275-0729
  • Fax: 609-275-3875
Mailing address:
  • Phone: 609-275-0729
  • Fax: 609-275-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA041256
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: