MEDICARE: ANGIE STALEY

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	235Z00000X	Speech-Language Pathologist	5522	NC

General Provider Information

NPI Number	:	1336074145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE STALEY

Provider Business Mailing Address
First Line	:	45 OLDE FARM RD
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-6599
Country	:	US
Telephone Number	:	919-542-9868
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 OLDE FARM RD
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-6599
Country	:	US
Telephone Number	:	919-542-9868
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ ANGIE STALEY ” Practice Location

Language	Start Address	Practice Location

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