Provider Demographics
NPI:1417199811
Name:WAKEFIELD MEDICAL SPECIALTY SERVICES INC
Entity Type:Organization
Organization Name:WAKEFIELD MEDICAL SPECIALTY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-570-5277
Mailing Address - Street 1:123 CAPCOM AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6517
Mailing Address - Country:US
Mailing Address - Phone:919-570-5277
Mailing Address - Fax:919-570-5377
Practice Address - Street 1:123 CAPCOM AVE STE 3
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6517
Practice Address - Country:US
Practice Address - Phone:919-570-5277
Practice Address - Fax:919-570-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic