Healthcare Provider Details

I. General information

NPI: 1699655316
Provider Name (Legal Business Name): NYOTA ADVANCED WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WOOD RD STE 305
BRAINTREE MA
02184-2514
US

IV. Provider business mailing address

140 WOOD RD STE 305
BRAINTREE MA
02184-2514
US

V. Phone/Fax

Practice location:
  • Phone: 857-246-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NADEGE TAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 857-246-9393