Provider Demographics
NPI:1932763844
Name:BRADFORD, SHELBY B (MCN, RD, LD)
Entity type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:B
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MCN, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E BROAD ST UNIT 1642
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9778
Mailing Address - Country:US
Mailing Address - Phone:972-821-9557
Mailing Address - Fax:972-525-4731
Practice Address - Street 1:10300 N CENTRAL EXPY STE 325
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8657
Practice Address - Country:US
Practice Address - Phone:972-821-9557
Practice Address - Fax:972-525-4731
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85131133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered