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NPI Code Detail

MEDICARE: MRS. SOAUD CORNELL

MEDICARE: MRS. SOAUD CORNELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-22-210762FL

General Provider Information

NPI Number : 1508507914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SOAUD CORNELL
Provider Business Mailing Address
First Line : 1939 MAGUIRE RD # 107-108
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-7942
Country : US
Telephone Number : 407-619-8156
Fax Number :
Provider Business Practice Location Address
First Line : 1939 MAGUIRE RD # 107-108
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-7942
Country : US
Telephone Number : 407-619-8156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2022
Last Update Date : 07/25/2024

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