Provider Demographics
NPI:1295913226
Name:RETZKY, SANDRA SUE (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:RETZKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MARCELLA RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3451
Mailing Address - Country:US
Mailing Address - Phone:302-540-3463
Mailing Address - Fax:
Practice Address - Street 1:146 MARCELLA RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3451
Practice Address - Country:US
Practice Address - Phone:302-540-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDO 0358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology