MEDICARE: OPULENT HEALTH WELLNESS BEAUTY

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1992596860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPULENT HEALTH WELLNESS BEAUTY

Provider Business Mailing Address
First Line	:	2686 W MAIN ST STE 1
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-1992
Country	:	US
Telephone Number	:	845-202-0520
Fax Number	:	207-881-4915

Provider Business Practice Location Address
First Line	:	2686 W MAIN ST STE 1
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-1992
Country	:	US
Telephone Number	:	845-202-0520
Fax Number	:	207-881-4915

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	CASANDRA WAY
Credential	:	NP
Telephone Number	:	845-202-0520

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	05/13/2025

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