Provider Demographics
NPI:1255726899
Name:SHYAM, NIKHIL (MD)
Entity type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:
Last Name:SHYAM
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 1:995 OLD EAGLE SCHOOL RD STE 304F
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1701
Mailing Address - Country:US
Mailing Address - Phone:610-688-3099
Mailing Address - Fax:610-687-5350
Practice Address - Street 1:995 OLD EAGLE SCHOOL RD STE 304F
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1701
Practice Address - Country:US
Practice Address - Phone:610-688-3099
Practice Address - Fax:610-687-5350
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300052207N00000X
390200000X
PAMD472334207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program