Provider Demographics
NPI:1073808200
Name:DUFFUS, DEANDREA YVONNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEANDREA
Middle Name:YVONNE
Last Name:DUFFUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530730
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32753-0730
Mailing Address - Country:US
Mailing Address - Phone:904-355-1553
Mailing Address - Fax:
Practice Address - Street 1:110 POND CT
Practice Address - Street 2:STE 101
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2717
Practice Address - Country:US
Practice Address - Phone:386-777-3266
Practice Address - Fax:386-774-9096
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3632213ES0103X
FL390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program