Cornelius Smith

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-23-262611 Issued in FL

Practice address

22655 Bayshore Rd
Port Charlotte, FL 33980-2018

Phone

(941) 451-9743

NPI assigned

Mar 13, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1912608464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 BAL HARBOR BLVD",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339506512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22655 BAYSHORE RD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802018",
            "telephone_number": "941-451-9743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CORNELIUS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-23-262611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skilled Nursing Care Medical Group LLC
• Crystal Smedley
• Brennan Colette Smith
• Cassidy Smith
• Clement Gustavous Smith, CAREGIVER
• Dona Kristine Smith
• Joel W Smith, ATC
• Joletta A Smith
• Karen A Smith, RN
• Kevin E Smith, MD

• Behavior Technician in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.