Healthcare Provider Details

I. General information

NPI: 1700918950
Provider Name (Legal Business Name): NANANAMIBIA DUFFY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WHITE SPRUCE BLVD SUITE 200
ROCHESTER NY
14623-1606
US

IV. Provider business mailing address

300 WHITE SPRUCE BLVD SUITE 200
ROCHESTER NY
14623-1606
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-6770
  • Fax: 585-424-6776
Mailing address:
  • Phone: 585-424-6770
  • Fax: 585-424-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC7-0003516
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number258049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: