Healthcare Provider Details

I. General information

NPI: 1013159482
Provider Name (Legal Business Name): JEFFREY S MACDANIELS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number301357
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number301357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: