MEDICARE: WILLOW BROOK FAMILY MEDICINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1730044207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW BROOK FAMILY MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	7012 BAYOU CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-0200
Country	:	US
Telephone Number	:	801-682-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 CAPITAL DR STE 102
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-6477
Country	:	US
Telephone Number	:	801-682-6510
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH MOJAZZA
Credential	:	PA
Telephone Number	:	801-682-6510

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	02/09/2026

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