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General NPI Number Information
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NPI Number | 1417613282
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Entity Type | Individual
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Provider Name | OLIVIA PATRICE DEBELLIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 125 QUEENS RD STE 540
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City | CHARLOTTE
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State | NC
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Zip | 28204-3512
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Country | US
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Telephone | 980-302-6560
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Fax | 980-302-6565
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone |
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA062993
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-12882
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License Number State | NC
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