Individual provider · Type 1 NPI

Marissa Destefano, PA-C

Surgical Physician Assistant · Wilmington, DE

NPI number 1750103479 Active

Practice location

1941 Limestone Rd Ste 101
Wilmington, DE 19808-5413

Mailing address

100 Patura Rd
Modena, NY 12548-5310

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X25MP00947700 (NJ)
Physician Assistant 363A00000XC5-0012164 (DE)

Surgical Physician Assistant: Definition to come...

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About NPI 1750103479

Marissa Destefano, PA-C's National Provider Identifier is 1750103479, issued on Oct 25, 2024. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Wilmington, DE. The record was last updated on Sep 10, 2025.