Healthcare Provider Details

I. General information

NPI: 1962011809
Provider Name (Legal Business Name): SYDNEY BOULIER MS, RD, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY BOVENDER

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-1404
  • Fax:
Mailing address:
  • Phone: 619-534-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND9880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: