Provider Demographics
NPI:1538976469
Name:CORNELL, SHERRY A
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
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 1:5308 MAIN ST APT 11
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48450-9202
Mailing Address - Country:US
Mailing Address - Phone:810-712-2533
Mailing Address - Fax:
Practice Address - Street 1:5308 MAIN ST APT 11
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-9202
Practice Address - Country:US
Practice Address - Phone:810-712-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician