Healthcare Provider Details

I. General information

NPI: 1255215463
Provider Name (Legal Business Name): SOVANA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N ALBEMARLE ST
MC LEAN VA
22101-4222
US

IV. Provider business mailing address

1701 N ALBEMARLE ST
MC LEAN VA
22101-4222
US

V. Phone/Fax

Practice location:
  • Phone: 917-325-8376
  • Fax:
Mailing address:
  • Phone: 917-325-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHVENDERMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-325-8376