Provider Demographics
NPI:1306597737
Name:BRADSHAW, ASHLEY BROOKSHIRE (MS, RD, CSO, LDN)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:BROOKSHIRE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MS, RD, CSO, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 GREY ELM TRL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7265
Mailing Address - Country:US
Mailing Address - Phone:252-299-0692
Mailing Address - Fax:
Practice Address - Street 1:460 WATERSTONE DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9078
Practice Address - Country:US
Practice Address - Phone:984-215-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004922133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered