Provider Demographics
NPI:1366652125
Name:DELELLIS, STEPHEN MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:DELELLIS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:136 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1240
Mailing Address - Country:US
Mailing Address - Phone:910-643-0729
Mailing Address - Fax:910-643-1113
Practice Address - Street 1:2817 REILLY ROAD MCXC-COD CREDENTIALS
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-643-0729
Practice Address - Fax:901-643-1113
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC103216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant