Healthcare Provider Details

I. General information

NPI: 1942714464
Provider Name (Legal Business Name): KELLY DIGREGORIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

1107 MANTUA PIKE STE 720-220
MANTUA NJ
08051-1606
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-4175
  • Fax: 302-320-6403
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012391
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067442
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00456300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: