Provider Demographics
NPI:1649817552
Name:DUFFY, CHRISTOPHER MATTHEW (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:DUFFY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2123 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4622
Mailing Address - Country:US
Mailing Address - Phone:239-209-1415
Mailing Address - Fax:
Practice Address - Street 1:2123 GROVE ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4622
Practice Address - Country:US
Practice Address - Phone:239-209-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112579363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical