Individual
MS. SHERYLLYN BOULAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3001 W DR MARTIN LUTHER KING JR BLVD, 1ST FLOOR CHILDREN'S ADM, TAMPA, FL 33607-6307
(813) 870-4619
(813) 554-8956
Mailing address
3001 W DR MLK BLVD, TAMPA, FL 33607-6307
(813) 554-8527
(813) 554-8496
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015859700
—
FL
Enumeration date
03/19/2015
Last updated
04/03/2023
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