# WAKE SPECIALTY PHYSICIANS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WakeMed Physician Practices Pediatric Weight Management, WakeMed Pediatric Weight Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710434691
- **Authorized official:** MARIA JAYOUSSI (EXECUTIVE DIRECTOR, FINANCE)
- **Authorized official phone:** (919) 350-6089

## Contact information

- **Practice address:** 23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
- **Practice address phone:** (919) 350-6439
- **Practice address fax:** (919) 231-0314
- **Mailing address:** PO BOX 602195, CHARLOTTE, NC 28260-2195
- **Mailing address phone:** (919) 350-0554

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NC | — |
| 2080B0002X | Pediatric Obesity Medicine Physician | — | NC | Yes |

## Other

- **Enumeration date:** 09/08/2016
- **Last updated:** 06/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1942440373 | — | NC |