Healthcare Provider Details

I. General information

NPI: 1306465653
Provider Name (Legal Business Name): ALESSANDRA CLAIRE CARRILLO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3013
US

IV. Provider business mailing address

135 PAGE RD N
PINEHURST NC
28374-4607
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-8383
  • Fax: 336-718-9622
Mailing address:
  • Phone: 419-463-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2024-01567
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2024-01567
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: