Healthcare Provider Details

I. General information

NPI: 1942856661
Provider Name (Legal Business Name): MELINDA SUE GUGLIELMETTI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 BROWNING PL
RALEIGH NC
27609-6536
US

IV. Provider business mailing address

3949 BROWNING PL
RALEIGH NC
27609-6536
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-7411
  • Fax:
Mailing address:
  • Phone: 919-787-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09332
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: