Healthcare Provider Details

I. General information

NPI: 1205763034
Provider Name (Legal Business Name): ANTHONY CUNAVELIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S WINOOSKI AVE
BURLINGTON VT
05401-7406
US

IV. Provider business mailing address

300 FLYNN AVE
BURLINGTON VT
05401-5301
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6920
  • Fax: 802-488-6919
Mailing address:
  • Phone: 802-488-6000
  • Fax: 802-488-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0136426
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: