Provider Demographics
NPI:1437809761
Name:MCDUFFIE, SHAAIR IMANI (MHC-LP)
Entity Type:Individual
Prefix:MS
First Name:SHAAIR
Middle Name:IMANI
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WOHLERS AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-2516
Mailing Address - Country:US
Mailing Address - Phone:716-857-1985
Mailing Address - Fax:
Practice Address - Street 1:1500 BROADWAY ST STE 170
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1861
Practice Address - Country:US
Practice Address - Phone:716-422-2002
Practice Address - Fax:716-893-0128
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor