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General NPI Number Information
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NPI Number | 1508620303
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Entity Type | Individual
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Provider Name | VIVIAN MANDAS PA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 800 OAK RIDGE TPKE STE C100
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City | OAK RIDGE
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State | TN
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Zip | 37830-6927
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Country | US
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Telephone | 865-483-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 2733 SILICON VALLEY WAY
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City | KNOXVILLE
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State | TN
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Zip | 37931-4288
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Country | US
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Telephone | 347-981-3905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | TN
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