Healthcare Provider Details

I. General information

NPI: 1932207024
Provider Name (Legal Business Name): RAYMOND GREGORY LANDE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14480 SUNBRIDGE CIR
WINTER GARDEN FL
34787
US

IV. Provider business mailing address

14480 SUNBRIDGE CIR
WINTER GARDEN FL
34787-4532
US

V. Phone/Fax

Practice location:
  • Phone: 240-277-8330
  • Fax:
Mailing address:
  • Phone: 240-277-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS15297
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number564
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number0564
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: