Active NPI
Amy Mack, MS, RD, CSP, CNSC
- Pediatric Nutrition Registered Dietitian
- Seattle, WA
National Provider Identifier
1629440318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nutrition Registered Dietitian
- License
- DI 60597926
- Practice address
- 4800 Sand Point Way NE
M/S Oa 5.210
Seattle, WA 98105-3901 - Phone
- (206) 987-4758
- NPI assigned
- Oct 21, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | DI 60597926 | WA | Primary |
Addresses
Primary practice location
4800 Sand Point Way NE
M/S Oa 5.210
Seattle, WA 98105-3901
Mailing address
4800 Sand Point Way NE
M/S Oa 5.210
Seattle, WA 98105-3901
Phone (206) 987-4758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI 60597926 | WA | MD | Pediatric Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445385600000",
"number": "1629440318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4800 SAND POINT WAY NE",
"address_2": "M/S OA 5.210",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981053901",
"telephone_number": "206-987-4758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 SAND POINT WAY NE",
"address_2": "M/S OA 5.210",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981053901",
"telephone_number": "206-987-4758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "AMY",
"credential": "MS, RD, CSP, CNSC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-21",
"last_updated": "2015-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "WA",
"license": "DI 60597926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.