Provider Demographics
NPI:1427406644
Name:CORNELIUS, DARRELL (HIS)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:DARRELL
Other - Middle Name:
Other - Last Name:CORNELIUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HIS
Mailing Address - Street 1:3214 CANNA LILY CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-5466
Mailing Address - Country:US
Mailing Address - Phone:713-569-0245
Mailing Address - Fax:
Practice Address - Street 1:510 BERING DR
Practice Address - Street 2:SUITE 364
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1457
Practice Address - Country:US
Practice Address - Phone:713-569-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80486237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist