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General NPI Number Information
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NPI Number | 1972464766
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Entity Type | Individual
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Provider Name | MS. SANDRA STARK JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 6859 BELFORT OAKS PL
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6242
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Country | US
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Telephone | 718-215-5311
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Fax | 718-865-5165
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Provider Business Mailing Address
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Address Line | 2001 HODGES BLVD APT 1208
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City | JACKSONVILLE
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State | FL
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Zip | 32224-3045
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Country | US
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Telephone | 904-361-1890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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