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Individual

MRS. POLLY DUFFUS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4420 NW 23RD ST, LAUDERHILL, FL 33313-3521
(754) 214-3169
Mailing address
4420 NW 23RD ST, LAUDERHILL, FL 33313-3521
(754) 214-3169

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
10-2752GH
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
22444710
FL
Enumeration date
02/03/2022
Last updated
02/03/2022
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