Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tiffany Kelly Disanzo

Individual provider Physician Assistant · NPI 1043917354

Tiffany Kelly Disanzo is a Physician Assistant in Raleigh, North Carolina. Qualified in 2023, 3 years ago. Practices with Wakemed Specialists Group LLC, a 869-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
3
Licensed in
NC
In the registry since
2023
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone: (919) 350-8000
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 0010-13523 (NC)
Physician Assistant Taxonomy 363A00000X · Licence 0010-13523 (NC)

Record details

NPI number1043917354
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 8, 2023
Last updated in NPPESSeptember 12, 2023
Certification dateSeptember 12, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Wakemed Specialists Group Llc — 869 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Raleigh