=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598291999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESATTO NUTRITION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2017
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2143 NE BROADWAY ST STE 6
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97232-1512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-949-5499
-----------------------------------------------------
Fax | 855-503-4979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13171 NE SHAVER ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97230-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-949-5499
-----------------------------------------------------
Fax | 855-503-4979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIETITIAN, OWNER
-----------------------------------------------------
Name | AMY ESATTO
-----------------------------------------------------
Credential | RDN
-----------------------------------------------------
Telephone | 503-949-5499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 10162720
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------