Healthcare Provider Details

I. General information

NPI: 1902750284
Provider Name (Legal Business Name): MYORA INTEGRATED HEALTH AND PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FAIRMOUNT AVE SUITE 109
HYDE PARK MA
02136-2775
US

IV. Provider business mailing address

11 FAIRMOUNT AVE STE 109
HYDE PARK MA
02136-2777
US

V. Phone/Fax

Practice location:
  • Phone: 617-300-7176
  • Fax:
Mailing address:
  • Phone: 617-300-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE BALFOUR
Title or Position: OWNER
Credential: NP
Phone: 617-300-7176