MEDICARE: DR. BRANDY GARDNER PSYD

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	103TC0700X	Clinical Psychologist	0810008496	VA
2	103TC0700X	Clinical Psychologist	PSY-004547	AZ

General Provider Information

NPI Number	:	1134528896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDY GARDNER PSYD

Provider Business Mailing Address
First Line	:	12118 CLUB RIDGE DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-2750
Country	:	US
Telephone Number	:	808-429-0812
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 LORI RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6626
Country	:	US
Telephone Number	:	808-429-0812
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	03/03/2026

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