Individual
JENNIFER LAIACONA CAICEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8045 PROVIDENCE RD STE 300, CHARLOTTE, NC 28277
(704) 341-9600
(855) 380-3762
Mailing address
8045 PROVIDENCE RD STE 300, CHARLOTTE, NC 28277-8915
(704) 341-9600
(855) 380-3762
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
2009-00855
NC
208000000X
Pediatrics Physician
2009-00855
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10434901113
—
NC
05
—
AA53535215
—
SC
Enumeration date
11/06/2007
Last updated
07/21/2022
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