Healthcare Provider Details

I. General information

NPI: 1336955715
Provider Name (Legal Business Name): VITALITY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13312 CAMBRIDGE VILLAGE LOOP
APEX NC
27502-7173
US

IV. Provider business mailing address

5601 SORRELL CROSSING DR
RALEIGH NC
27617-8301
US

V. Phone/Fax

Practice location:
  • Phone: 984-223-9585
  • Fax: 910-230-1948
Mailing address:
  • Phone: 919-667-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICHOLE POSILLIPO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 910-599-7093