Healthcare Provider Details

I. General information

NPI: 1497097240
Provider Name (Legal Business Name): SAFE HARBOR GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ANGLERS RD SUITE 103
LEWES DE
19958-1105
US

IV. Provider business mailing address

PO BOX 495
LEWES DE
19958-0495
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-9641
  • Fax: 302-644-9646
Mailing address:
  • Phone: 302-644-9641
  • Fax: 410-548-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC20005792
License Number StateDE

VIII. Authorized Official

Name: NANCY MONDERO
Title or Position: OWNER
Credential: DO
Phone: 302-644-9641