Individual
SANDRA LINDSAY BOISSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4620 S LABURNUM AVE, RICHMOND, VA 23231-2424
(804) 222-7474
(804) 222-0458
Mailing address
4620 S LABURNUM AVE, RICHMOND, VA 23231-2424
(804) 222-7474
(804) 222-0458
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101031925
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010199450
—
VA
01
—
1426978
CIGNA
VA
01
—
293614
MAMSI
VA
01
—
333717
ANTHEM BSBS OF VA
VA
01
—
4065057
AETNA LIFE
VA
01
—
45892
SENTARA
VA
01
—
79152
SOUTHERN HEALTH SERVICES
VA
Enumeration date
06/19/2006
Last updated
11/24/2009
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