MEDICARE: DR. AMY GAIDELIS 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	PSY32448	CA

General Provider Information

NPI Number	:	1255147559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY GAIDELIS PSYD

Provider Business Mailing Address
First Line	:	PO BOX 279556
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-9556
Country	:	US
Telephone Number	:	916-776-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 O ST # MS -10
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5804
Country	:	US
Telephone Number	:	916-776-0898
Fax Number	:

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

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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