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General NPI Number Information
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NPI Number | 1366652125
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Entity Type | Individual
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Provider Name | STEPHEN MICHAEL DELELLIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 3622 N MAIN ST
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City | HOPE MILLS
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State | NC
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Zip | 28348-1937
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Country | US
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Telephone | 910-423-7771
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Fax | 910-423-4177
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Provider Business Mailing Address
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Address Line | 136 TIMBERLAKE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1240
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Country | US
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Telephone | 910-643-0729
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Fax | 910-643-1113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 103216
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License Number State | NC
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