Healthcare Provider Details

I. General information

NPI: 1669547709
Provider Name (Legal Business Name): LINDA C AIDALA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1693
US

IV. Provider business mailing address

56 COLONIAL CIR
BUFFALO NY
14213-1467
US

V. Phone/Fax

Practice location:
  • Phone: 716-352-7295
  • Fax:
Mailing address:
  • Phone: 716-352-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0088311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: