Healthcare Provider Details

I. General information

NPI: 1619811585
Provider Name (Legal Business Name): BELLA ROSE BEAUTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BOSTON POST RD STE 1
ORANGE CT
06477-3534
US

IV. Provider business mailing address

370 BOSTON POST RD STE 1
ORANGE CT
06477-3534
US

V. Phone/Fax

Practice location:
  • Phone: 203-996-0950
  • Fax:
Mailing address:
  • Phone: 203-996-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MICHELE ANTONUCCI
Title or Position: OWNER
Credential:
Phone: 203-996-0950