Healthcare Provider Details

I. General information

NPI: 1619364726
Provider Name (Legal Business Name): DESIRE N KETCHANDJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARRISH ST
CANANDAIGUA NY
14424-1731
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 604
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-919-2668
  • Fax: 585-396-6455
Mailing address:
  • Phone: 585-275-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number315109
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD194535
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number71748
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD29090
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number315109
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number71748
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: