Healthcare Provider Details

I. General information

NPI: 1871989012
Provider Name (Legal Business Name): AMY ESATTO RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 E BURNSIDE ST
PORTLAND OR
97214-1424
US

IV. Provider business mailing address

3824 SE 98TH AVE
PORTLAND OR
97266-2502
US

V. Phone/Fax

Practice location:
  • Phone: 503-949-5499
  • Fax:
Mailing address:
  • Phone: 503-949-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D- 10162720
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: