Provider Demographics
NPI:1619166733
Name:VELEZ, SONDRA ROSE (CNM)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:ROSE
Last Name:VELEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SONDRA
Other - Middle Name:
Other - Last Name:KALCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:18101 OAKWOOD BLVD STE 124
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-7490
Practice Address - Fax:313-593-8685
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230258367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife