Provider Demographics
NPI:1427342203
Name:VEDVYAS, CHETAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:
Last Name:VEDVYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13691 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4318
Mailing Address - Country:US
Mailing Address - Phone:239-561-3376
Mailing Address - Fax:239-561-3020
Practice Address - Street 1:329 E OLYMPIA AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3833
Practice Address - Country:US
Practice Address - Phone:239-561-3376
Practice Address - Fax:239-561-3020
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247840390200000X
FLME127511207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program