Healthcare Provider Details

I. General information

NPI: 1518761824
Provider Name (Legal Business Name): IDYLLIUM BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4153 NE 9TH PL
CAPE CORAL FL
33909-6231
US

IV. Provider business mailing address

4153 NE 9TH PL
CAPE CORAL FL
33909-6231
US

V. Phone/Fax

Practice location:
  • Phone: 727-272-5640
  • Fax:
Mailing address:
  • Phone: 727-272-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHEILA LORES
Title or Position: OWNER/MANAGER
Credential: APRN, PMHNP-BC
Phone: 727-272-5640