# WAKEMED SPECIALISTS GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WakeMed ENT-Head & Neck Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053976415
- **Authorized official:** MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
- **Authorized official phone:** (919) 350-6089

## Contact information

- **Practice address:** 3024 NEW BERN AVE, RALEIGH, NC 27610-1247
- **Practice address phone:** (919) 350-7856
- **Mailing address:** 2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
- **Mailing address phone:** (919) 350-0552
- **Mailing address fax:** (919) 350-7687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | — | NULL | — |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | — | — | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | NULL | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 05/01/2019
- **Last updated:** 05/01/2019