Koren H. Bradshaw, MS, CLC
NPI 1205308012ActiveIndividual· Nutritionist· Fairfield, CT
Nutritionist (MS, CLC) in Fairfield, Connecticut, with an NPI issued in December 2018.
Overview
| NPI | 1205308012 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | MS, CLC |
| Sole proprietor | Yes |
| NPI issued | Dec 19, 2018 |
| Last updated in NPPES | Dec 19, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nutritionist Primary | 133N00000X | — | — |
| Nutritionist, Nutrition, Education | 133NN1002X | — | — |
| Lactation Consultant, Non-RN | 174N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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