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General NPI Number Information
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NPI Number | 1114367802
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Entity Type | Individual
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Provider Name | TAMELIA D LAKRAJ-EDWARDS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 4531 NW GLAZBROOK ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1338
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Country | US
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Telephone | 772-780-2396
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Fax | 616-226-4454
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Provider Business Mailing Address
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Address Line | 4531 NW GLAZBROOK ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1338
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Country | US
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Telephone | 772-780-2396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME163629
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | ME163629
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License Number State | FL
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