Healthcare Provider Details

I. General information

NPI: 1982832473
Provider Name (Legal Business Name): PRASHANT PRAKASH DESHMANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MEDICAL CENTER DR STE 115
FAYETTEVILLE NY
13066-6636
US

IV. Provider business mailing address

301 PROSPECT AVE MSO
SYRACUSE NY
13203-1807
US

V. Phone/Fax

Practice location:
  • Phone: 315-329-2555
  • Fax:
Mailing address:
  • Phone: 315-448-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number283294
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: