Basic Information
| Provider Information | |||||||||
| NPI: | 1730573668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VYAS | ||||||||
| FirstName: | NIKKI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 PINE STREET | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133519294 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 745 ORIENTA AVE STE 1201 | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327015676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072600158 | ||||||||
| FaxNumber: | 4073392906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2015 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 60-286263 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZP0102X | ME149252 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.