Provider Demographics
NPI:1508507914
Name:CORNELL, SOAUD
Entity type:Individual
Prefix:MRS
First Name:SOAUD
Middle Name:
Last Name:CORNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 MAGUIRE RD # 107-108
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7942
Mailing Address - Country:US
Mailing Address - Phone:407-619-8156
Mailing Address - Fax:
Practice Address - Street 1:1939 MAGUIRE RD # 107-108
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7942
Practice Address - Country:US
Practice Address - Phone:407-619-8156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-210762106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician