Provider Demographics
NPI:1700918950
Name:DUFFY, NANANAMIBIA (MD)
Entity Type:Individual
Prefix:DR
First Name:NANANAMIBIA
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WHITE SPRUCE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1606
Mailing Address - Country:US
Mailing Address - Phone:585-424-6770
Mailing Address - Fax:585-424-6776
Practice Address - Street 1:300 WHITE SPRUCE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1606
Practice Address - Country:US
Practice Address - Phone:585-424-6770
Practice Address - Fax:585-424-6776
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0003516207R00000X
NY258049207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400042083Medicare PIN