Organization
WAKEMED SPECIALISTS GROUP LLC
Active
Other names
WakeMed Children's Pediatric Urology
Organization subpart
No
Provider details
NPI number
Authorized official
SHONDRA LYNN BRINK (VP WPP OPERATIONS)
(919) 350-6045
Entity
Organization
Contact information
Practice address
3024 NEW BERN AVE, RALEIGH, NC 27610-1247
(919) 350-7251
(919) 350-1606
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0552
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
—
—
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Enumeration date
04/01/2021
Last updated
04/01/2021
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