Individual
TIFFANY KELLY DISANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
63 HAVISTOCK CT, CAMERON, NC 28326-6330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-13523
NC
363AS0400X
Surgical Physician Assistant
Primary
0010-13523
NC
Other
Enumeration date
02/08/2023
Last updated
09/12/2023
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