Individual
AMY DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3100
Mailing address
2501 BLUE RIDGE RD STE 250, RALEIGH, NC 27607-6346
(919) 863-4128
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36096
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041M
BLUE SHIELD
NC
05
—
891041M
—
NC
01
—
P00184463
RR MEDICARE
NC
Enumeration date
09/22/2006
Last updated
03/07/2023
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