MEDICARE: ILY MEDICAL CORPS 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1356293187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILY MEDICAL CORPS LLC

Provider Business Mailing Address
First Line	:	23442 MORELAND AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-2558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23442 MORELAND AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-2558
Country	:	US
Telephone Number	:	239-738-1113
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IELETH SAHILY LOPEZ VALLADARES
Credential	:	APRN
Telephone Number	:	239-738-1113

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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