MEDICARE: IDYLLIUM BEHAVIORAL HEALTH PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1518761824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDYLLIUM BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	4153 NE 9TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-6231
Country	:	US
Telephone Number	:	727-272-5640
Fax Number	:

Provider Business Practice Location Address
First Line	:	4153 NE 9TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-6231
Country	:	US
Telephone Number	:	727-272-5640
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	SHEILA LORES
Credential	:	APRN, PMHNP-BC
Telephone Number	:	727-272-5640

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	12/15/2025

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