Provider Demographics
NPI:1164132080
Name:KAVIANI FAZ, GELAREH (AUD)
Entity Type:Individual
Prefix:
First Name:GELAREH
Middle Name:
Last Name:KAVIANI FAZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:GELAREH
Other - Middle Name:
Other - Last Name:KAVYANI FAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:341 WALLACE RD STE D
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8001
Mailing Address - Country:US
Mailing Address - Phone:615-832-2200
Mailing Address - Fax:615-832-2020
Practice Address - Street 1:341 WALLACE RD STE D
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8001
Practice Address - Country:US
Practice Address - Phone:615-832-2200
Practice Address - Fax:615-832-2020
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2135231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist