Provider Demographics
NPI:1255147559
Name:GAIDELIS, AMY (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:GAIDELIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 279556
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-9556
Mailing Address - Country:US
Mailing Address - Phone:916-776-0898
Mailing Address - Fax:
Practice Address - Street 1:1215 O ST # MS -10
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5804
Practice Address - Country:US
Practice Address - Phone:916-776-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32448103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical