IndividualActive
Koren Bradshaw, MS, CLC
NPI 1205308012 · Nutritionist · Fairfield, CT
Provider details
- NPI number
- 1205308012
- Entity type
- Individual
- Primary specialty
- NutritionistDietary & Nutritional Service Providers
- Credential
- MS, CLC
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Dietary & Nutritional Service Providers
- Nutrition Education Nutritionist133NN1002X
Dietary & Nutritional Service Providers
- Lactation Consultant (Non-RN)174N00000X
Other Service Providers
Practice location
32 Ermine St
Fairfield, CT 06824-5109
Phone: (617) 827-5223
Approximate (ZIP-level) locationGet directions
Mailing address
32 Ermine St
Fairfield, CT 06824-5109
Registry dates
- Enumerated
- 2018-12-19
- Last updated
- 2018-12-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.