Healthcare Provider Details

I. General information

NPI: 1831916469
Provider Name (Legal Business Name): SAMANTHA DUFFIE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9456 CHARLOTTE HWY STE 106
FORT MILL SC
29707-7953
US

IV. Provider business mailing address

9456 CHARLOTTE HWY STE 106
INDIAN LAND SC
29707-7953
US

V. Phone/Fax

Practice location:
  • Phone: 803-219-1995
  • Fax:
Mailing address:
  • Phone: 803-219-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005216
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9671
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL018444
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: