This study explores the influence of cryogenic supersonic fine particle bombardment (CSFPB) on a Ni–W–Co–Ta medium heavy alloy (MHA), and focus on the effect of gas pressure and impact time on the surface integrity, microstructural evolution, and mechanical properties of the MHA. CSFPB treatment creates a gradient structure, including surface layer with nanograins down to 9.0 nm due to severe plastic deformation, subsurface layer with high density dislocation structures and deformation twins due to weakened impact energy, and undeformed matrix. A key advantage of CSFPB is seen to be the cryogenic environment, which promotes superior surface integrity by reduced roughness. As the impact duration and gas pressure increase, the depth of deformation layer, surface hardness and strength of the MHA progressively rise. The optimal combination of strength and ductility is achieved at a gas pressure of 1.0 MPa for a duration of 90 s. This setting results in a maximum ultimate tensile strength of 1351 MPa and yield strength 796 MPa, with uncompromising elongation. However, excessively long treatment durations or high gas pressures can lead to the formation of surface microcracks, ultimately reducing the MHA's strength. Therefore, CSFPB offers the benefit of improved surface integrity through the cryogenic environment while maintaining a desirable balance between enhanced strength and ductility.