Healthcare Provider Details

I. General information

NPI: 1780676056
Provider Name (Legal Business Name): SHEFALI VYAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD SHORT HILLS RD SUITE 505
WEST ORANGE NJ
07052-1000
US

IV. Provider business mailing address

101 OLD SHORT HILLS RD STE 505
WEST ORANGE NJ
07052-1023
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-6767
  • Fax: 973-322-6780
Mailing address:
  • Phone: 973-322-6767
  • Fax: 973-322-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number226092
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMA080095
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: