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General NPI Number Information
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NPI Number | 1720144637
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Entity Type | Individual
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Provider Name | CAUDREAN LATISTE AVERY-BENJAMIN MD
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 1918 RANDOLPH RD SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28207-1100
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Country | US
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Telephone | 704-377-5675
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Fax | 704-335-8163
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 704-377-5675
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Fax | 704-335-8163
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD430442
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 200800028
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License Number State | NC
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