Healthcare Provider Details

I. General information

NPI: 1669471918
Provider Name (Legal Business Name): ELOISE R COLASANTO-SAIA R.D., LDN, C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 SW CUTOFF SUITE B
NORTHBOROUGH MA
01532-2159
US

IV. Provider business mailing address

34 THOMAS FARM CIR
SHREWSBURY MA
01545-4057
US

V. Phone/Fax

Practice location:
  • Phone: 508-340-0729
  • Fax: 508-475-7148
Mailing address:
  • Phone: 508-340-0729
  • Fax: 508-475-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number176
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: