# WAKEMED SPECIALISTS GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WakeMed Childrens Pediatric Weight Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962067314
- **Authorized official:** MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
- **Authorized official phone:** (919) 350-6089

## Contact information

- **Practice address:** 23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
- **Practice address phone:** (919) 235-6439
- **Practice address fax:** (919) 231-0314
- **Mailing address:** PO BOX 603949, CHARLOTTE, NC 28260-3949
- **Mailing address phone:** (919) 350-0552
- **Mailing address fax:** (919) 350-7687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080B0002X | Pediatric Obesity Medicine Physician | — | NULL | Yes |
| 2080B0002X | Pediatric Obesity Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2019
- **Last updated:** 08/19/2019