Active NPI
Shelby Jackson
- Behavior Analyst
- Virginia Beach, VA
National Provider Identifier
1891267910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 4001 Virginia Beach Blvd Ste 117
Virginia Beach, VA 23452-1759 - Phone
- (916) 479-4328
- NPI assigned
- Dec 31, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | VA | Primary | |
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
4001 Virginia Beach Blvd Ste 117
Virginia Beach, VA 23452-1759
Mailing address
128 N Berwick Cres
Virginia Beach, VA 23452-2316
Phone (916) 479-4328
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68-0396223 | Medicaid | CA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758153600000",
"number": "1891267910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 N BERWICK CRES",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234522316",
"telephone_number": "916-479-4328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 VIRGINIA BEACH BLVD STE 117",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234521759",
"telephone_number": "916-479-4328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHELBY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-31",
"last_updated": "2025-09-18",
"certification_date": "2025-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "VA",
"license": null,
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "68-0396223",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.