=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417052309
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VEDA R VYAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 09/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 LEE RD SUITE 220
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-740-0383
-----------------------------------------------------
Fax | 407-740-0470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 LEE RD SUITE 220
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-740-0383
-----------------------------------------------------
Fax | 407-740-0470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | ME0064487
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------