Provider Demographics
NPI:1396704458
Name:DUFFY, SALLY M (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:M
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:6845 FAIRVIEW RD
Mailing Address - Street 2:SOUTHPARK BEHAVIORAL MEDICINE SPECIALISTS PA
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210
Mailing Address - Country:US
Mailing Address - Phone:704-442-9065
Mailing Address - Fax:704-969-1175
Practice Address - Street 1:6845 FAIRVIEW RD
Practice Address - Street 2:SOUTHPARK BEHAVIORAL MEDICINE SPECIALISTS PA
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-442-9065
Practice Address - Fax:704-969-1175
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2814634CMedicare ID - Type Unspecified