Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Marissa Destefano, PA-C

Individual provider Surgical Physician Assistant · NPI 1750103479

Marissa Destefano, PA-C is a Physician Assistant in Wilmington, Delaware. Qualified in 2024, 2 years ago. Practices with Kennedy Medical Group Practice, PC, a 414-clinician group and accepts Medicare assignment. Licensed in Delaware and New Jersey.

Years since qualifying
2
Licensed in
DE, NJ
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1941 Limestone Rd Ste 101
Wilmington, DE 19808-5413
Phone: (302) 655-9494
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 25MP00947700 (NJ)
Physician Assistant Taxonomy 363A00000X · Licence C5-0012164 (DE)

Record details

NPI number1750103479
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 25, 2024
Last updated in NPPESSeptember 10, 2025
Certification dateSeptember 10, 2025
Mailing address100 Patura Rd, Modena, NY 12548-5310

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Kennedy Medical Group Practice, P.C. — 414 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Wilmington