MEDICARE: JASON LERAND GANDY MD

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	2084P0800X	Psychiatry Physician	LL33776	SC

General Provider Information

NPI Number	:	1003103730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON LERAND GANDY MD

Provider Business Mailing Address
First Line	:	3543 DREHER SHOALS RD STE 1
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-7608
Country	:	US
Telephone Number	:	803-216-1223
Fax Number	:	800-878-0910

Provider Business Practice Location Address
First Line	:	3543 DREHER SHOALS RD STE 1
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-7608
Country	:	US
Telephone Number	:	803-216-1223
Fax Number	:	800-878-0910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	11/17/2025

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