Healthcare Provider Details

I. General information

NPI: 1316225089
Provider Name (Legal Business Name): AMY D BRADSHAW RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 LUTHERAN PKWY STE 180
WHEAT RIDGE CO
80033-6000
US

IV. Provider business mailing address

500 ELDORADO BLVD STE 6250
BROOMFIELD CO
80021-3421
US

V. Phone/Fax

Practice location:
  • Phone: 303-403-7930
  • Fax: 303-425-2792
Mailing address:
  • Phone: 303-272-0768
  • Fax: 303-318-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: