Koren H. Bradshaw, MS, CLC

Primary specialty

NutritionistTaxonomy code 133N00000X

Practice address

32 Ermine St
Fairfield, CT 06824-5109

Phone

(617) 827-5223

NPI assigned

Dec 19, 2018

Last updated

Dec 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

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.

• Simplex Health

  • Registered Dietitian
  • Ambler, PA
  • NPI 1598137218
  NPD (past)

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1205308012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 ERMINE ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245109",
            "telephone_number": "617-827-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 ERMINE ST",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245109",
            "telephone_number": "617-827-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "KOREN",
        "middle_name": "H.",
        "credential": "MS, CLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-19",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Boxleitner, LPC
• Stacey Bozzuto, PT, DPT
• Patricia E Bradbury, BCABA
• Bradley W Bloom LCSW LLC
• Keith Bradley, MD
• Warren Joseph Brandt, OD
• Braun Orthodontics PLLC
• Max Braun, DDS
• Thomas F Braun, D.M.D.
• Samantha Breaz, PHARMD

• Nutritionist in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Nutritionist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; 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.