Provider Demographics
NPI:1295129377
Name:DAKERMANDJI, CAITLIN AZZARELLO (DO)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:AZZARELLO
Last Name:DAKERMANDJI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:AZZARELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:ONE MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-4625
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-5708
Practice Address - Country:US
Practice Address - Phone:336-716-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
NC2025-00885207P00000X
SC2278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003160448AMedicaid
SC2138PAMedicaid
SCNPI #OtherBLUE CHOICE, COMMERCIAL & MEDICAID
SCNPI #OtherBLUE CROSS
SCNPI #OtherTRICARE (AFFILIATION ONLY)
SC1068956OtherWELLCARE
GA003160448AMedicaid