Provider Demographics
NPI:1275426447
Name:KASSAHARA, ALINE
Entity type:Individual
Prefix:
First Name:ALINE
Middle Name:
Last Name:KASSAHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 SAN CLEMENTE PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1005
Mailing Address - Country:US
Mailing Address - Phone:561-299-1164
Mailing Address - Fax:
Practice Address - Street 1:7440 SAN CLEMENTE PL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-1005
Practice Address - Country:US
Practice Address - Phone:561-299-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10365133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered