Vivid Aesthetics & Wellness PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VIVID AESTHETICS & WELLNESS PLLC

Practice address

110 Court St
Cromwell, CT 06416-1273

Phone

(860) 250-9017

NPI assigned

Dec 12, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Selma Costa Rosa, APRNNPI 1457930158

Title

Nurse Practioner

Phone

(860) 250-9017

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian Benjamin Gomes, APRN

  • Family Nurse Practitioner
  • Cromwell, CT
  • NPI 1669972444
  Medicare reassignment Care Compare group NPD
• Selma Costa Rosa, FNP-BC

  • Nurse Practitioner
  • Newington, CT
  • NPI 1457930158
  Medicare reassignment NPD Authorized official
• Lynn Swanson, APRN

  • Nurse Practitioner
  • Berlin, CT
  • NPI 1073082343
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1861260671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 COURT ST",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064161273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 COURT ST",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064161273",
            "telephone_number": "860-250-9017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "117 Dowd St",
            "address_purpose": "LOCATION",
            "city": "Newington",
            "state": "CT",
            "postal_code": "061112608",
            "country_code": "US",
            "telephone_number": "860-250-9017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VIVID AESTHETICS & WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-12",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "ROSA",
        "authorized_official_first_name": "SELMA",
        "authorized_official_middle_name": "COSTA",
        "authorized_official_title_or_position": "NURSE PRACTIONER",
        "authorized_official_telephone_number": "860-250-9017",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikolaos Vassiliou, MD
• Shafali Verma, PHARMD
• Carrie Anne Verrilli, COTA/L
• Alane Villar, LCSW
• Madhvi Viroja, PTA
• Hany S Wahba, M.D.
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2299)
• Wal-Mart Stores East, LP. (Walmart pharmacy 10-3164)
• Walgreen Co (Walgreens # 09818)
• Danielle Marie Wallace

• Family Medicine Physician in Cromwell, CT
• Providers in Cromwell, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.