Provider Demographics
NPI:1073285219
Name:FLETCHER, ESHA (RD)
Entity Type:Individual
Prefix:MS
First Name:ESHA
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2433
Mailing Address - Country:US
Mailing Address - Phone:586-496-3933
Mailing Address - Fax:586-999-8633
Practice Address - Street 1:2727 2ND AVE STE SUITE266
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2658
Practice Address - Country:US
Practice Address - Phone:313-451-0405
Practice Address - Fax:586-999-8836
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86024432133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered