=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205799558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL CIOFFI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1138 PINE ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-5353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-488-6000
-----------------------------------------------------
Fax | 802-488-6919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 S WINOOSKI AVE
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-7406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-488-6934
-----------------------------------------------------
Fax | 802-488-6919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 097.0135746
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------