Healthcare Provider Details

I. General information

NPI: 1730091919
Provider Name (Legal Business Name): AGELESS BEAUTY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FORDHAM HILL OVAL
BRONX NY
10468-4854
US

IV. Provider business mailing address

418 BROADWAY STE R
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 917-743-7543
  • Fax:
Mailing address:
  • Phone: 917-743-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH MELCHOR
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 917-743-7543