Provider Demographics
NPI:1437448636
Name:CORNELIUS, SHEILA (MA BCBA)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5610
Mailing Address - Country:US
Mailing Address - Phone:317-361-9966
Mailing Address - Fax:
Practice Address - Street 1:1066 MISTY LYNN CIR
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4800
Practice Address - Country:US
Practice Address - Phone:317-361-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-10-7564103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1437448636Medicaid