Provider Demographics
NPI:1265762173
Name:FUGALLI, BELINDA KAYDIANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BELINDA
Middle Name:KAYDIANNE
Last Name:FUGALLI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-6949
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:1537 OWEN PARK LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3454
Practice Address - Country:US
Practice Address - Phone:910-485-8801
Practice Address - Fax:910-485-5605
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013763-1363AM0700X
NC0010-08902363AM0700X
NC001009802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-08902OtherLICENSE
NCMF7380479OtherDEA