Provider Demographics
NPI:1154556868
Name:DUFFY, SHANE DANIEL LEE
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:DANIEL LEE
Last Name:DUFFY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:DESMET
Mailing Address - State:SD
Mailing Address - Zip Code:57231
Mailing Address - Country:US
Mailing Address - Phone:605-203-1666
Mailing Address - Fax:
Practice Address - Street 1:609 1ST ST SW
Practice Address - Street 2:
Practice Address - City:DE SMET
Practice Address - State:SD
Practice Address - Zip Code:57231-2258
Practice Address - Country:US
Practice Address - Phone:605-203-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility