MEDICARE: SONYELLE MCMILLIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		MI

General Provider Information

NPI Number	:	1104626266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYELLE MCMILLIAN

Provider Business Mailing Address
First Line	:	8600 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2571
Country	:	US
Telephone Number	:	586-551-9102
Fax Number	:	586-551-9102

Provider Business Practice Location Address
First Line	:	8600 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2571
Country	:	US
Telephone Number	:	586-551-9102
Fax Number	:	586-551-9102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	05/26/2026

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Directions to “ SONYELLE MCMILLIAN ” Practice Location

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