Healthcare Provider Details

I. General information

NPI: 1427686906
Provider Name (Legal Business Name): SHAUNAK KRISHAN BAKSHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/03/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HINESBURG RD STE 201
SOUTH BURLINGTON VT
05403-7613
US

IV. Provider business mailing address

1100 HINESBURG RD STE 201
SOUTH BURLINGTON VT
05403-7613
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-1808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number338674-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number042.0018755
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: