Healthcare Provider Details

I. General information

NPI: 1275453037
Provider Name (Legal Business Name): MIRINDA BROWN TYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 COMMERCIAL ST
MASHPEE MA
02649-6507
US

IV. Provider business mailing address

2 MAPLE SWAMP RD
EAST SANDWICH MA
02537-1491
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-7090
  • Fax:
Mailing address:
  • Phone: 508-477-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN246728
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: