Healthcare Provider Details

I. General information

NPI: 1154269199
Provider Name (Legal Business Name): JED CASAUAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
WINSTON-SALEM NC
27107
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-6410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRTL26-0292
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: