MEDICARE: FABULOUSLY MADE SALON, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1669336764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FABULOUSLY MADE SALON, LLC

Provider Business Mailing Address
First Line	:	8909 REGENTS PARK DR STE 415
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3432
Country	:	US
Telephone Number	:	813-444-3229
Fax Number	:

Provider Business Practice Location Address
First Line	:	8909 REGENTS PARK DR STE 415
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3432
Country	:	US
Telephone Number	:	813-444-3229
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHANNA Y AMARANTE
Credential	:
Telephone Number	:	813-444-3229

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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