Provider Demographics
NPI:1538804596
Name:BOUDALI, SYLVIA HANNAH (CNM)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:HANNAH
Last Name:BOUDALI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 WINDER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-6419
Mailing Address - Country:US
Mailing Address - Phone:804-543-3738
Mailing Address - Fax:
Practice Address - Street 1:1122 N 25TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5254
Practice Address - Country:US
Practice Address - Phone:804-508-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184172367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife