MEDICARE: MRS. BELINDA KAYDIANNE FUGALLI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	013763-1	NY
2	363AM0700X	Medical Physician Assistant	0010-08902	NC
3	363A00000X	Physician Assistant	001009802	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010-08902	OTHER	NC	LICENSE

General Provider Information

NPI Number	:	1265762173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BELINDA KAYDIANNE FUGALLI PA-C

Provider Business Mailing Address
First Line	:	PO BOX 40908
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-0908
Country	:	US
Telephone Number	:	910-615-6949
Fax Number	:	910-615-9761

Provider Business Practice Location Address
First Line	:	1537 OWEN PARK LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3454
Country	:	US
Telephone Number	:	910-485-8801
Fax Number	:	910-485-5605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	07/23/2025

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Directions to “ MRS. BELINDA KAYDIANNE FUGALLI PA-C” Practice Location

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