MEDICARE: EESHA VASIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MD

General Provider Information

NPI Number	:	1659206480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EESHA VASIST

Provider Business Mailing Address
First Line	:	18612 HARVEST SCENE CT
Second Line	:
City	:	BOYDS
State	:	MD
Zip	:	20841-4374
Country	:	US
Telephone Number	:	240-543-6068
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 THOMAS JOHNSON DR STE G
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4673
Country	:	US
Telephone Number	:	240-543-6068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ EESHA VASIST ” Practice Location

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