MEDICARE: SHINING STARS APPLIED BEHAVIOR ANALYSIS CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346787728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINING STARS APPLIED BEHAVIOR ANALYSIS CORP.

Provider Business Mailing Address
First Line	:	1844 PENMAN RD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3734
Country	:	US
Telephone Number	:	904-755-0646
Fax Number	:	904-372-7620

Provider Business Practice Location Address
First Line	:	1844 PENMAN RD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3734
Country	:	US
Telephone Number	:	904-755-0646
Fax Number	:	904-372-7620

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	KRISTINA FRENCH
Credential	:	MPA
Telephone Number	:	904-755-0646

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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Directions to “SHINING STARS APPLIED BEHAVIOR ANALYSIS CORP. ” Practice Location

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