Provider Demographics
NPI:1588424188
Name:KELLY, SONYA N (ME D)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:N
Last Name:KELLY
Suffix:
Gender:F
Credentials:ME D
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:N
Other - Last Name:KELLY-DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:29950 SUMMIT DR APT 208
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2418
Mailing Address - Country:US
Mailing Address - Phone:248-954-6310
Mailing Address - Fax:
Practice Address - Street 1:29950 SUMMIT DR APT 208
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2418
Practice Address - Country:US
Practice Address - Phone:248-954-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide