Healthcare Provider Details

I. General information

NPI: 1538023775
Provider Name (Legal Business Name): TAMESHA GAY EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMESHA GAY SUCKRA

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 NW 3RD ST
PLANTATION FL
33317-2713
US

IV. Provider business mailing address

4517 NW 3RD ST
PLANTATION FL
33317-2713
US

V. Phone/Fax

Practice location:
  • Phone: 786-944-3003
  • Fax:
Mailing address:
  • Phone: 786-944-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberRBT-25-494156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: