Shereen Azam Alavian, MD, MPH
Individual provider Active NPI Pediatrics Physician · Clayton, NC
NPI 1508180274 · NPPES record last updated Jan 27, 2021
Key facts
- NPI
- 1508180274
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 2014-00836 (NC)
- Practice address
- 204 Medspring Dr
Clayton, NC 27520-9293 - Phone
- (919) 235-6505
- Fax
- (919) 350-7204
- NPI assigned
- Mar 24, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190523002174 | NC | Practitioner - Pediatric Medicine | 5799911863 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014-00836 | NC | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wakemed Specialists Group, LLC | Current | Accepting new patients | |
| Wake Specialty Physicians, LLC | Pediatrics | Current |
Accepting new patients |
| Wakemed Specialists Group LLC | Current |
Accepting new patients | |
| Wake Specialty Physicians LLC | Pediatrics | Current |
Accepting new patients |
| Wakemed Specialists Group LLC | Pediatrics | Current |
Accepting new patients |
Locations
204 Medspring Dr
Clayton, NC 27520
Phone (910) 775-3130
3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000
2820 Kidd Rd
Raleigh, NC 27610
Phone (919) 231-8315
2920 Highwoods Blvd
Raleigh, NC 27604
10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300
Interoperability endpoints
- salavian253431@directhisp.wakemed.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2014-00836 | NC | Yes |
Addresses
Primary practice location
204 Medspring Dr
Clayton, NC 27520-9293
Mailing address
2920 Highwoods Blvd
Raleigh, NC 27604-0010
Phone (877) 498-4490
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508180274 | Medicaid | NC |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | salavian253431@directHISP.wakemed.org | Direct |
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All providers in Clayton, NC · Pediatrics Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.