Healthcare Provider Details

I. General information

NPI: 1811532724
Provider Name (Legal Business Name): YVEDA BRUTUS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TURNPIKE ST STE 31
CANTON MA
02021-2855
US

IV. Provider business mailing address

435 SHREWSBURY ST
WORCESTER MA
01604-1689
US

V. Phone/Fax

Practice location:
  • Phone: 781-236-7342
  • Fax: 508-752-7245
Mailing address:
  • Phone: 508-753-5554
  • Fax: 508-752-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number2261311
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN2261311
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2261311
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: