Healthcare Provider Details

I. General information

NPI: 1114367802
Provider Name (Legal Business Name): TAMELIA D LAKRAJ-EDWARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMELIA D LAKRAJ MD

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 NW GLAZBROOK ST
PORT SAINT LUCIE FL
34983-1338
US

IV. Provider business mailing address

4531 NW GLAZBROOK ST
PORT SAINT LUCIE FL
34983-1338
US

V. Phone/Fax

Practice location:
  • Phone: 772-780-2396
  • Fax: 616-226-4454
Mailing address:
  • Phone: 772-780-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME163629
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME163629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: