Provider Demographics
NPI:1144964701
Name:GRUSZECZKA, SANDRA (MASTERS)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:GRUSZECZKA
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 E ROANOKE CT
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-5187
Mailing Address - Country:US
Mailing Address - Phone:405-833-3395
Mailing Address - Fax:
Practice Address - Street 1:1611 E ROANOKE CT
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-5187
Practice Address - Country:US
Practice Address - Phone:405-833-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist