Healthcare Provider Details

I. General information

NPI: 1083530232
Provider Name (Legal Business Name): SHONDA BOLER IMH-E
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W 25TH ST
RIVIERA BEACH FL
33404-4417
US

IV. Provider business mailing address

142 W 25TH ST
RIVIERA BEACH FL
33404-4417
US

V. Phone/Fax

Practice location:
  • Phone: 561-788-1775
  • Fax:
Mailing address:
  • Phone: 561-788-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number1521130300183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: