Provider Demographics
NPI:1669471918
Name:COLASANTO-SAIA, ELOISE R (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:ELOISE
Middle Name:R
Last Name:COLASANTO-SAIA
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 THOMAS FARM CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4057
Mailing Address - Country:US
Mailing Address - Phone:508-340-0729
Mailing Address - Fax:508-475-7148
Practice Address - Street 1:38 SW CUTOFF
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2159
Practice Address - Country:US
Practice Address - Phone:508-340-0729
Practice Address - Fax:508-475-7148
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0040Medicare PIN
P45169Medicare UPIN