Organization
WAKE SPECIALTY PHYSICIANS LLC
Active
Other names
WakeMed Physician Practices Pediatric Weight Management, WakeMed Pediatric Weight Management
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR, FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
(919) 350-6439
(919) 231-0314
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0554
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
NC
2080B0002X
Pediatric Obesity Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440373
—
NC
Enumeration date
09/08/2016
Last updated
06/16/2018
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