Individual provider Active NPI

Andrea Stayton, MS, BCBA

  • Behavior Analyst
  • St Augustine, FL
National Provider Identifier
1205071917
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-07-3966 Issued in NU
Practice address
175 Cumberland Park Dr Ste 100
Saint Augustine, FL 32095-8955
Phone
(904) 201-9129
NPI assigned
Dec 9, 2008
Last updated
Aug 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-07-3966 NU Primary

Addresses

Primary practice location

175 Cumberland Park Dr Ste 100
Saint Augustine, FL 32095-8955

Mailing address

23 Sol CT
St Augustine, FL 32095-8493
Phone (904) 307-3318

Other practice location 1

23 Sol Ct
St Augustine, FL 32095-8493
Phone (904) 307-3318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
ABA Connection, LLC Behavior Analyst CurrentSince Aug 25, 2025 Accepting new patients

Locations

175 Cumberland Park Dr
Ste 100
St Augustine, FL 32095
Phone (904) 201-9129

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755734400000",
    "number": "1205071917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 SOL CT",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958493",
            "telephone_number": "904-307-3318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CUMBERLAND PARK DR STE 100",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320958955",
            "telephone_number": "904-201-9129"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23 Sol Ct",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320958493",
            "country_code": "US",
            "telephone_number": "904-307-3318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAYTON",
        "first_name": "ANDREA",
        "credential": "MS, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-09",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": "1-07-3966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; 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.