Active NPI
Shalysa Annita Childress, MA, BCBA
- Behavior Analyst
- Brooklyn, NY
National Provider Identifier
1679045256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-19-39348
- Practice address
- 1255 E 31St St
Brooklyn, NY 11210-4740 - Phone
- (888) 320-3222
- NPI assigned
- Dec 20, 2018
- Last updated
- May 27, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-19-39348 | NU | Primary |
Addresses
Primary practice location
1255 E 31St St
Brooklyn, NY 11210-4740
Mailing address
1255 E 31St St
Brooklyn, NY 11210-4740
Other practice location 1
8302 Espresso Dr Ste 100
Bakersfield, CA 93312-5688
Phone (469) 694-1754
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-19-39348 | Other | BCBA CERTIFICATE | |
| 0046179 | Medicaid | OH |
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 Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Kid Spot Center | Behavior Analyst | Past | Accepting new patients |
| Junior Boom ABA LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Behavior Analyst
- Brooklyn, NY
- NPI 1861194490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748304000000",
"number": "1679045256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1255 E 31ST ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112104740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1255 E 31ST ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112104740",
"telephone_number": "888-320-3222"
}
],
"practiceLocations": [
{
"address_1": "8302 Espresso Dr Ste 100",
"address_purpose": "LOCATION",
"city": "Bakersfield",
"state": "CA",
"postal_code": "933125688",
"country_code": "US",
"telephone_number": "469-694-1754",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHILDRESS",
"first_name": "SHALYSA",
"middle_name": "ANNITA",
"credential": "MA, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-20",
"last_updated": "2025-05-27",
"certification_date": "2025-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": "1-19-39348",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBA CERTIFICATE",
"identifier": "1-19-39348",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0046179",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.