Healthcare Provider Details

I. General information

NPI: 1114852043
Provider Name (Legal Business Name): CAMERON BOLINDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SUNRISE VALLEY DR STE 405
RESTON VA
20191-5302
US

IV. Provider business mailing address

11800 SUNRISE VALLEY DR STE 405
RESTON VA
20191-5302
US

V. Phone/Fax

Practice location:
  • Phone: 703-574-8885
  • Fax:
Mailing address:
  • Phone: 703-574-8885
  • Fax: 703-415-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: