Dedra Sally, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

583 Issued in NC

Practice address

10010 Falls of Neuse Rd
Suite 205
Raleigh, NC 27614-8494

Phone

(919) 350-1380

Fax

(919) 350-7918

NPI assigned

Oct 13, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wake Specialty Physicians, LLC

  • Surgery Physician
  • Raleigh, NC
  • NPI 1942440375
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1821492315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10010 FALLS OF NEUSE RD",
            "address_2": "SUITE 205",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148494",
            "telephone_number": "919-350-1380",
            "fax_number": "919-556-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 FALLS OF NEUSE RD",
            "address_2": "SUITE 205",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148494",
            "telephone_number": "919-350-1380",
            "fax_number": "919-350-7918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLY",
        "first_name": "DEDRA",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-13",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NJ",
            "license": "25ME00056001",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NJ",
            "license": "25ME00056000",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NC",
            "license": "583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821492315",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald David Salguero, CRNA
• Miranda Leann Saling Aultman, LCSW
• Kathryn Star Salisbury, AG-ACNP
• Aissatou C Sall
• Michele Laporte Sallean, LCSW
• Aqsa Salman, LCMHC
• Angela Maria Salmon, CRNA
• Lauren Livesay Salmon
• Mark D. Salopek, O.D.
• Salt Castle Lake

• Advanced Practice Midwife in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Advanced Practice Midwife in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.