NPIMap

Organization Active NPI

Shining Stars Applied Behavior Analysis Corp.

  • Community/Behavioral Health Agency
  • Jacksonville, FL
National Provider Identifier
1346787728
Registry record updated Apr 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SHINING STARS APPLIED BEHAVIOR ANALYSIS CORP.
Practice address
4540 Southside Blvd
Jacksonville, FL 32216-5492
Phone
(904) 755-0646
Fax
(904) 372-7620
NPI assigned
Jan 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2026

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

Authorized official

Name
Jaime Clark
Title
Coo
Phone
(904) 755-0646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

4540 Southside Blvd
Jacksonville, FL 32216-5492

Mailing address

100 Lora St
Neptune Beach, FL 32266-4939
Phone (904) 755-0646

Other practice location 1

8382 Baymeadows Rd Ste 9
Jacksonville, FL 32256-7436
Phone (904) 755-0646

Other practice location 2

1135 Beach Blvd
Jacksonville Beach, FL 32250-3445
Phone (904) 755-0646

National Provider Directory

National Provider Directory

Locations

8382 Baymeadows Rd
Ste 9
Jacksonville, FL 32256
Phone (904) 755-0646

4540 Southside Blvd
Jacksonville, FL 32216
Phone (904) 503-1065

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776038400000",
    "number": "1346787728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LORA ST",
            "city": "NEPTUNE BEACH",
            "state": "FL",
            "postal_code": "322664939",
            "telephone_number": "904-755-0646",
            "fax_number": "904-372-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 SOUTHSIDE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165492",
            "telephone_number": "904-755-0646",
            "fax_number": "904-372-7620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8382 Baymeadows Rd Ste 9",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322567436",
            "country_code": "US",
            "telephone_number": "904-755-0646",
            "fax_number": "904-372-7620",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1135 Beach Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville Beach",
            "state": "FL",
            "postal_code": "322503445",
            "country_code": "US",
            "telephone_number": "904-755-0646",
            "fax_number": "904-352-7620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHINING STARS APPLIED BEHAVIOR ANALYSIS CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2026-04-13",
        "certification_date": "2026-04-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "904-755-0646"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2026; 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.