Provider Demographics
NPI:1861139974
Name:COLANNINO, HAYLEE GOLD (MS, RD)
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:GOLD
Last Name:COLANNINO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 W WATERS AVE APT 905
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1434
Mailing Address - Country:US
Mailing Address - Phone:401-447-2276
Mailing Address - Fax:
Practice Address - Street 1:4747 W WATERS AVE APT 905
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1434
Practice Address - Country:US
Practice Address - Phone:401-447-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86331779133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered