MEDICARE: GRACEMYLEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1013750660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEMYLEY LLC

Provider Business Mailing Address
First Line	:	6803 ANOKA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-4030
Country	:	US
Telephone Number	:	786-848-5749
Fax Number	:

Provider Business Practice Location Address
First Line	:	6803 ANOKA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-4030
Country	:	US
Telephone Number	:	786-848-5749
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLEGUY VERDIEU
Credential	:
Telephone Number	:	786-848-5749

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	07/18/2024

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Directions to “GRACEMYLEY LLC ” Practice Location

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