Provider Demographics
NPI:1790311405
Name:CHASKA, KAREN (MS, RD, LD/N, LRD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CHASKA
Suffix:
Gender:F
Credentials:MS, RD, LD/N, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 PORT ROYALE DR S APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7916
Mailing Address - Country:US
Mailing Address - Phone:952-486-2728
Mailing Address - Fax:
Practice Address - Street 1:3333 PORT ROYALE DR S APT 103
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7916
Practice Address - Country:US
Practice Address - Phone:952-486-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8111133V00000X
SC2035133V00000X
86054081133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty