Healthcare Provider Details

I. General information

NPI: 1487516076
Provider Name (Legal Business Name): INFINITE WELLNESS AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13436 246TH ST
ROSEDALE NY
11422-1445
US

IV. Provider business mailing address

13436 246TH ST
ROSEDALE NY
11422-1445
US

V. Phone/Fax

Practice location:
  • Phone: 917-283-8536
  • Fax:
Mailing address:
  • Phone: 917-283-8536
  • 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: NOVLET DAVIS
Title or Position: OWNER
Credential:
Phone: 917-283-8536