# WAKE SPECIALTY PHYSICIANS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WakeMed H&V Advanced Heart Failure
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841713187
- **Authorized official:** MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
- **Authorized official phone:** (919) 350-6089

## Contact information

- **Practice address:** 3000 NEW BERN AVE STE 1200, RALEIGH, NC 27610-1231
- **Practice address phone:** (919) 350-7600
- **Practice address fax:** (919) 350-8333
- **Mailing address:** PO BOX 602195, CHARLOTTE, NC 28260-2195
- **Mailing address phone:** (919) 350-0552
- **Mailing address fax:** (919) 350-7687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0001X | Advanced Heart Failure and Transplant Cardiology Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |

## Other

- **Enumeration date:** 07/19/2017
- **Last updated:** 10/25/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1942440375 | — | NC |