Healthcare Provider Details

I. General information

NPI: 1902809593
Provider Name (Legal Business Name): SHELDON MARC BUZNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 WORCESTER ST SUITE 301
WELLESLEY MA
02482-5341
US

IV. Provider business mailing address

28 HUCKLEBERRY HILL RD
LINCOLN MA
01773-3509
US

V. Phone/Fax

Practice location:
  • Phone: 781-772-1791
  • Fax: 781-489-5315
Mailing address:
  • Phone: 617-864-6350
  • Fax: 617-864-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39203
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number39203
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: