Provider Demographics
NPI:1124609078
Name:PETTY, AMY JIAYUE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JIAYUE
Last Name:PETTY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JIAYUE
Other - Middle Name:
Other - Last Name:DENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 DUKE MEDICINE CIR # 3K
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-4000
Mailing Address - Country:US
Mailing Address - Phone:919-684-3432
Mailing Address - Fax:
Practice Address - Street 1:40 DUKE MEDICINE CIR # 3K
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4000
Practice Address - Country:US
Practice Address - Phone:919-684-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302705390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty