Provider Demographics
NPI:1316225089
Name:BRADSHAW, AMY D (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:D
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD STE 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3421
Mailing Address - Country:US
Mailing Address - Phone:303-272-0768
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:3555 LUTHERAN PKWY STE 180
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6000
Practice Address - Country:US
Practice Address - Phone:303-403-7930
Practice Address - Fax:303-425-2792
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered