Healthcare Provider Details

I. General information

NPI: 1114840808
Provider Name (Legal Business Name): CECILE CHEMEZOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN ST STE 3A
BURLINGTON VT
05401-8439
US

IV. Provider business mailing address

155 MARKET ST APT 5
SOUTH BURLINGTON VT
05403-6653
US

V. Phone/Fax

Practice location:
  • Phone: 802-829-1518
  • Fax:
Mailing address:
  • Phone: 571-235-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0137044
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: