Healthcare Provider Details

I. General information

NPI: 1659342384
Provider Name (Legal Business Name): VAFA CYRUS MANSOURI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 WALLACE RD STE 414
NASHVILLE TN
37211-8010
US

IV. Provider business mailing address

397 WALLACE RD STE 414
NASHVILLE TN
37211-8010
US

V. Phone/Fax

Practice location:
  • Phone: 615-333-0851
  • Fax: 615-333-0852
Mailing address:
  • Phone: 615-284-7260
  • Fax: 615-284-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1875
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number1875
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: