Healthcare Provider Details

I. General information

NPI: 1508721028
Provider Name (Legal Business Name): SONJA BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 PINE ST
TAYLOR MI
48180-1778
US

IV. Provider business mailing address

6549 PINE ST
TAYLOR MI
48180-1778
US

V. Phone/Fax

Practice location:
  • Phone: 248-671-8472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number802658765
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: