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General NPI Number Information
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NPI Number | 1346852407
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Entity Type | Organization
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Legal Business Name | WAKE SPECIALTY PHYSICIANS
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 2001 S MAIN ST STE 200
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City | WAKE FOREST
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State | NC
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Zip | 27587-1652
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Country | US
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Telephone | 919-235-6540
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Fax | 919-235-6504
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Provider Business Mailing Address
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Address Line | 2001 S MAIN ST STE 200
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City | WAKE FOREST
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State | NC
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Zip | 27587-1652
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Country | US
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Telephone | 919-235-6540
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Fax | 919-235-6504
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | SHONDRA LYNN BRINK
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Credential |
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Telephone | 919-350-6045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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