Healthcare Provider Details

I. General information

NPI: 1700719143
Provider Name (Legal Business Name): MR. ANUJ MEHTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

22 ANNA MARSH LN
DUMMERSTON VT
05301-3292
US

IV. Provider business mailing address

653 AMHERST RD UNIT 3204
SUNDERLAND MA
01375-0504
US

V. Phone/Fax

Practice location:
  • Phone: 802-258-3737
  • Fax:
Mailing address:
  • Phone: 608-982-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: