Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WakeMed Pediatric Cardiology
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXEC DIRECTOR, FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
(919) 235-6422
(919) 231-0314
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
06/13/2017
Last updated
07/21/2022
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