Provider Demographics
NPI:1730573668
Name:VYAS, NIKKI (MD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:VYAS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 620111
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-0111
Mailing Address - Country:US
Mailing Address - Phone:321-765-3564
Mailing Address - Fax:
Practice Address - Street 1:89 ALAFAYA WOODS BLVD # 1075
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6235
Practice Address - Country:US
Practice Address - Phone:321-765-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-286263207ZP0102X
390200000X
FLME149252207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program