Provider Demographics
NPI:1235282666
Name:DUFFY, SEAN REID (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:REID
Last Name:DUFFY
Suffix:
Gender:M
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:PO BOX 370622
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0622
Mailing Address - Country:US
Mailing Address - Phone:702-360-2800
Mailing Address - Fax:702-360-2878
Practice Address - Street 1:1885 VILLAGE CENTER CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6369
Practice Address - Country:US
Practice Address - Phone:702-360-2800
Practice Address - Fax:702-360-2878
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV70312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEF05796Medicare UPIN
NEVMD7031Medicare ID - Type UnspecifiedMEDICARE ID