Healthcare Provider Details

I. General information

NPI: 1396744934
Provider Name (Legal Business Name): ALLEN STUART MANDIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 22ND AVE N
NASHVILLE TN
37203-1844
US

IV. Provider business mailing address

336 22ND AVE N
NASHVILLE TN
37203-1844
US

V. Phone/Fax

Practice location:
  • Phone: 615-346-8182
  • Fax: 877-870-7862
Mailing address:
  • Phone: 615-346-8182
  • Fax: 877-870-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD034282
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberU0717
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number89391
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberEMC0002637
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberD0054114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: