Sheryllyn Boulay, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

3001 W Dr Martin Luther King Jr Blvd
1St Floor Children's Adm
Tampa, FL 33607-6307

Phone

(813) 870-4619

Fax

(813) 554-8956

NPI assigned

Mar 19, 2015

Last updated

Apr 3, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. Joseph's Hospital, Inc.

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1447132634
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1063806834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 W DR MLK BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076307",
            "telephone_number": "813-554-8527",
            "fax_number": "813-554-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W DR MARTIN LUTHER KING JR BLVD",
            "address_2": "1ST FLOOR CHILDREN'S ADM",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076307",
            "telephone_number": "813-870-4619",
            "fax_number": "813-554-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULAY",
        "first_name": "SHERYLLYN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-19",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015859700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David J Boudreaux, PH.D.
• Tami M Boudreaux, PT
• Willdith Niana Boue
• Alaa Boulad, M.D.
• Sandnes Smith Boulanger, LCSW
• Christina Boulding, LCSW
• Boulevard Dental Citrus Park, LLC
• Alice Mendez Boullosa, M.S.W., L.M.F.T.
• Eriny Boulos, DMD
• Christina S Bourbon, CCC-SLP

• Medical Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.