# VIVID AESTHETICS & WELLNESS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861260671
- **Authorized official:** SELMA COSTA ROSA APRN (NURSE PRACTIONER)
- **Authorized official phone:** (860) 250-9017

## Contact information

- **Practice address:** 110 COURT ST, CROMWELL, CT 06416-1273
- **Practice address phone:** (860) 250-9017
- **Mailing address:** 110 COURT ST, CROMWELL, CT 06416-1273

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/12/2023
- **Last updated:** 12/06/2024