Healthcare Provider Details

I. General information

NPI: 1265236525
Provider Name (Legal Business Name): SULTANA PERVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 BACKLICK RD STE 216
SPRINGFIELD VA
22150-2806
US

IV. Provider business mailing address

6560 BACKLICK RD STE 216
SPRINGFIELD VA
22150-2806
US

V. Phone/Fax

Practice location:
  • Phone: 703-930-2490
  • Fax: 571-775-3803
Mailing address:
  • Phone: 703-930-2490
  • Fax: 571-775-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0005772
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0005772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: