Healthcare Provider Details

I. General information

NPI: 1063347946
Provider Name (Legal Business Name): NATASHA VAFIADIS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 LEVANTE AVE
CORAL GABLES FL
33146-2416
US

IV. Provider business mailing address

3811 SHIPPING AVE APT 908
MIAMI FL
33146-1585
US

V. Phone/Fax

Practice location:
  • Phone: 917-349-2611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: