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General NPI Number Information
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NPI Number | 1982131843
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Entity Type | Organization
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Legal Business Name | SPECTRUM FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 519 KEISLER DR STE 104
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City | CARY
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State | NC
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Zip | 27518-7098
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Country | US
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Telephone | 919-741-3186
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Fax | 919-400-4365
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Provider Business Mailing Address
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Address Line | 222 DARBYTOWN PL
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City | CARY
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State | NC
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Zip | 27513-4279
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Country | US
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Telephone | 919-741-3186
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUJATHA SAJEEVAN
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Credential | MD
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Telephone | 919-741-3186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2009-01871
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License Number State | NC
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