Active NPI
Gwyneth Lynnette Bradshaw, RD
- Registered Dietitian
- Salisbury, MD
National Provider Identifier
1093331928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DX4449
- Practice address
- 724 E Main St
Salisbury, MD 21804-5037 - Phone
- (443) 397-6647
- NPI assigned
- Jun 16, 2020
- Last updated
- Jun 16, 2020
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DX4449 | MD | Primary |
Addresses
Primary practice location
724 E Main St
Salisbury, MD 21804-5037
Mailing address
724 E Main St
Salisbury, MD 21804-5037
Phone (443) 397-6647
Other names 1
- Gwyneth Lynnette Hazel
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
724 E Main St
Salisbury, MD 21804-5037
Phone (443) 397-6647
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fixer Upper Fitness LLC | Dietitian, Registered | Current | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Locations
724 E Main St
Salisbury, MD 21804
Phone (443) 397-6647
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592265600000",
"number": "1093331928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 E MAIN ST",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218045037",
"telephone_number": "443-397-6647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 E MAIN ST",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218045037",
"telephone_number": "443-397-6647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "GWYNETH",
"middle_name": "LYNNETTE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-16",
"last_updated": "2020-06-16",
"certification_date": "2020-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MD",
"license": "DX4449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "GWYNETH",
"last_name": "HAZEL",
"middle_name": "LYNNETTE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Salisbury, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.