Provider Demographics
NPI:1043559156
Name:BENDA, CAITLIN MARGARET (MS, RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARGARET
Last Name:BENDA
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 OLD CORRAL ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4638
Mailing Address - Country:US
Mailing Address - Phone:704-246-7306
Mailing Address - Fax:
Practice Address - Street 1:6301 OLD CORRAL ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4638
Practice Address - Country:US
Practice Address - Phone:704-246-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003450133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered