Healthcare Provider Details

I. General information

NPI: 1114613387
Provider Name (Legal Business Name): BRENO LIMA LIMA ANDRADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 FALMOUTH RD STE 101
HYANNIS MA
02601-2324
US

IV. Provider business mailing address

1030 FALMOUTH RD STE 101
HYANNIS MA
02601-2324
US

V. Phone/Fax

Practice location:
  • Phone: 774-552-3209
  • Fax:
Mailing address:
  • Phone: 774-552-3209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1026215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: