# WAKEMED SPECIALISTS GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WakeMed Children's Pediatric Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184202830
- **Authorized official:** SHONDRA LYNN BRINK (VP WPP OPERATIONS)
- **Authorized official phone:** (919) 350-6045

## Contact information

- **Practice address:** 3024 NEW BERN AVE, RALEIGH, NC 27610-1247
- **Practice address phone:** (919) 350-7251
- **Practice address fax:** (919) 350-1606
- **Mailing address:** PO BOX 603949, CHARLOTTE, NC 28260-3949
- **Mailing address phone:** (919) 350-0552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 2088P0231X | Pediatric Urology Physician | — | NULL | Yes |
| 2088P0231X | Pediatric Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/01/2021
- **Last updated:** 04/01/2021