WAKE SPECIALTY PHYSICIANS, LLC (NPI# 1861922775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861922775 |
| Entity Type | Organization |
| Organization Name | WAKE SPECIALTY PHYSICIANS, LLC |
| Other Organization Name | WAKEMED PEDIATRIC CARDIOLOGY |
| Practice Address |
23 Sunnybrook Rd Raleigh NC 27610-1855 |
| Mailing Address |
Po Box 602195 Charlotte NC 28260-2195 |
| Practice Telephone | 9192356422 |
| Practice Fax Number | 9192310314 |
| Mailing Telephone | (919) 350-0552 |
| Mailing Fax Number | 9193507687 |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2017-07-13 |
| Authorized Official Name | MARIA JAYOUSSI (EXEC DIRECTOR, FINANCE) |
| Authorized Official Telephone | 9193506089 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1942440375 | 05 |
| Other Name | Type Code |
|---|---|
| WakeMed Pediatric Cardiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588216253 | Wake Specialty Physicians, LLC | Pediatrics | 204 Medspring Dr, Clayton, NC 27520-9293 | 2019-07-12 |
| 1346722865 | Wake Specialty Physicians, LLC | Orthopaedic Surgery | 120 Healthplex Way Ste 206, Apex, NC 27502-8403 | 2018-08-31 |
| 1811304678 | Wake Specialty Physicians, LLC | Durable Medical Equipment & Medical Supplies | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2014-07-14 |
| 1649686577 | Wake Specialty Physicians, LLC | Orthopaedic Surgery | 222 Ashville Ave Ste 20, Cary, NC 27518-6130 | 2014-07-11 |
| 1659934511 | Wake Specialty Physicians, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-04-17 |
| 1922591049 | Wake Specialty Physicians, LLC | Surgery | 160 Macgregor Pines Dr, Cary, NC 27511-6036 | 2018-06-13 |
| 1760861678 | Wake Specialty Physicians, LLC | Obstetrics & Gynecology | 10010 Falls of Neuse Rd, Raleigh, NC 27614-8494 | 2015-05-26 |
| 1619374261 | Wake Specialty Physicians, LLC | Urology | 218 Ashville Ave, Cary, NC 27518-6118 | 2014-11-25 |
| 1740680222 | Wake Specialty Physicians, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2014-09-03 |
| 1447667209 | Wake Specialty Physicians, LLC | Orthopaedic Surgery | 3009 New Bern Ave, Raleigh, NC 27610-1214 | 2014-07-14 |
| Street Address |
23 SUNNYBROOK RD |
| City | RALEIGH |
| State | NC |
| Zip Code | 27610-1855 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386648756 | James A Scovil | Legal Medicine | 23 Sunnybrook Rd, Ste 109, Raleigh, NC 27610-1855 | 2005-06-13 |
| 1861030371 | Macon Louise Cornick Guidry | Dietitian, Registered | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-12-16 |
| 1679129720 | Amelia Willis | Nurse Practitioner | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-08-14 |
| 1497307334 | Wakemed Specialists Group LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-07-11 |
| 1336704766 | Wakemed Specialists Group, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-05-01 |
| 1265097695 | Wakemed Specialists Group, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-05-01 |
| 1245895697 | Wakemed Specialists Group, LLC | Counselor | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-05-01 |
| 1982269346 | Wakemed Specialists Group, LLC | Surgery | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-05-01 |
| 1962067314 | Wakemed Specialists Group, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-05-01 |
| 1659934511 | Wake Specialty Physicians, LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-04-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609499243 | Elizabeth Ranganai Mavindidze | Social Worker | Wakemed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610 | 2020-05-18 |
| 1851958839 | Alex & Associates, P.C. | Dentist | 1600 Cross Link Road, Unit 103, Raleigh, NC 27610 | 2019-05-24 |
| 1639646367 | Carol Mary Medins | Dietitian, Registered | Wakemed Raleigh Medical Park, 23 Sunnybrook Road, Suite 200, Raleigh, NC 27610 | 2018-10-31 |
| 1144714601 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 123 Sunnybrook Rd Ste 150, Raleigh, NC 27610 | 2018-06-19 |
| 1417446006 | Eagles Eye Lab, Inc | Clinical Medical Laboratory | 4501 New Bern Ave, Ste: 130, Raleigh, NC 27610 | 2018-05-09 |
| 1316465206 | Jeffery King Neer | Social Worker | 3010 Falstaff Rd., C/o Unc Actt, Raleigh, NC 27610 | 2017-08-31 |
| 1083139885 | Kelsey Daniel Mccleave | Social Worker | 3630 Enduring Freedom Drive, Raleigh, NC 27610 | 2017-08-14 |
| 1891219093 | Tarheel Residential Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4840 Quarryman Road, Raleigh, NC 27610 | 2017-07-29 |
| 1508214826 | Compassionate Care Providers LLC | Respite Care | 5110 Wetlands, Raleigh, NC 27610 | 2016-05-26 |
| 1730552530 | Matthew Belair | Pharmacist | 1601-51 Cross Link Rd, Raleigh, NC 27610 | 2015-11-03 |
| Find all providers in zip 27610 | ||||
| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548525470 | Bailliard Henry Pediatric Cardiology | Pediatrics | 4301 Lake Boone Trail, Suite 300, Raleigh, NC 27607 | 2012-07-06 |
| 1013571405 | Wakemed Specialists Group, LLC | Pediatrics | 10010 Falls of Neuse Rd, Raleigh, NC 27614-8495 | 2019-05-01 |
| 1437239829 | Blair Robinson | Pediatrics | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2006-10-17 |
| 1578653200 | George Henry | Pediatrics | 2304 Wesvill Ct, Suite 320, Raleigh, NC 27607-2973 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912354374 | Carolina Children's Heart Specialists | Pediatrics | 1018 W H Smith Boulevard, Greenville, NC 27834 | 2016-05-16 |
| 1215317060 | Forsyth Memorial Hospital, Inc | Pediatrics | 1941 New Garden Road, Suite 216, Greensboro, NC 27410 | 2015-06-08 |
| 1487903423 | Private Diagnostic Clinic, Pllc | Pediatrics | 540 New Waverly Place, Ste.101, Cary, NC 27518-7422 | 2012-09-06 |
| 1275858698 | Carolinas Physicians Network, Inc. | Pediatrics | 705 Griffith Street, Suite 100, Davidson, NC 28036-9305 | 2010-03-29 |
| 1073838496 | Carolinas Physicians Network, Inc. | Pediatrics | 6030 West Highway 74, Suite F, Indian Trail, NC 28079-3469 | 2010-03-29 |
| 1952626376 | Carolinas Physicians Network, Inc. | Pediatrics | 14214 Ballantyne Lake Road, Suite 150, Charlotte, NC 28277-3373 | 2010-03-29 |
| 1902121320 | Carolinas Physicians Network Inc | Pediatrics | 16623 Birkdale Cmns Pkwy Ste 110, Huntersville, NC 28078-5622 | 2010-03-29 |
| 1801023494 | Patsy W Park | Pediatrics | 1545 Orchard Villas Ave Ste 110, Apex, NC 27502-4339 | 2009-06-22 |
| 1114152469 | Frances Chen Travelli | Pediatrics | 1718 E 4th St Ste 605, Charlotte, NC 28204-3282 | 2009-05-15 |
| 1558350504 | Craig A. Greene | Pediatrics | 1781 Tate Blvd Se, Suite 203, Hickory, NC 28602-4251 | 2005-10-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.