Healthcare Provider Details

I. General information

NPI: 1962321893
Provider Name (Legal Business Name): TRUDY GULLETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5744 HILLTOP NEEDMORE RD
FUQUAY VARINA NC
27526-9280
US

IV. Provider business mailing address

5744 HILLTOP NEEDMORE RD
FUQUAY VARINA NC
27526-9280
US

V. Phone/Fax

Practice location:
  • Phone: 984-316-5206
  • Fax:
Mailing address:
  • Phone: 984-316-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4558
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: