MAMTA SHAH (Credential# 1006611) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
MAMTA SHAH is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0050723. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is Department of Nephrology, Farmington, CT 06030-0001. The current status is active.
| Licensee Name | MAMTA SHAH |
| Credential ID | 1006611 |
| Credential Number | CSP.0050723 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
Department of Nephrology Farmington CT 06030-0001 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2011-07-25 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2018-12-28 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1414677 | 1.056501 | Physician/Surgeon | 2017-06-06 | 2019-10-01 - 2020-09-30 | ACTIVE |
| 1490976 | 1.059078-RES | Resident Physician | 2015-06-24 | 2015-06-24 - 2020-06-30 | ACTIVE |
| Street Address | DEPARTMENT OF NEPHROLOGY |
| City | FARMINGTON |
| State | CT |
| Zip Code | 06030-0001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Wendy A Miller | Mc1921 Farmington Ave # 263, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jason J Ziegler | 2 Courthouse Square, Farmington, CT 06030-0001 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Bryden T Considine | L2104 of Medicine Rm, Farmington, CT 06030-0001 | Resident Physician | 2017-07-03 ~ 2021-06-30 |
| Dillon Paulo | 4260 Cordoba Ct, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Erica Shen Nofziger | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2027-06-30 |
| Omar Ibrahim | 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jillian L Fortier | Uconn Health Center, Department of Surgery, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Douglas Zelisko | 263 Farmington Ave Dept Of, Farmington, CT 06030-0001 | Physician/surgeon | 2020-04-23 ~ 2021-01-31 |
| Ruchir D Trivedi | 263 Farmington Ave # Mc-1405, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Rawan J.j. Sarsour | 263 Farmington Ave # Mc3905, Farmington, CT 06030-0001 | Provisional Faculty Dentist | 2020-04-21 ~ 2021-04-30 |
| Find all Licenses in zip 06030-0001 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eric Anthony Brueckner | 263 Farmington Ave., Farmington, CT 06030 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Derrick B Bremang | Residency Program, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| David M Shafer | Uconn Health Center, Farmington, CT 06030 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Michael J Murphy | Dept of Dermatology, Farmington, CT 06030 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Richard F Kaplan | Univ. of Ct., Farmington, CT 06030 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Nicholas George Vitale | 22 Woods Drive, Norwich, CT 06030 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Bruce E Gould | Univ of Conn Health Center, Farmington, CT 06030 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Vinayak M Sathe | Uconn Health Center,263 Farmington Ave, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shobhana Pathani | Department of Medicine, 263 Farmington Ave, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Patricia L Almeida | John Dempsey Hospital, Farmington, CT 06030 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in zip 06030 | |||
| City | FARMINGTON |
| Zip Code | 06030 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + FARMINGTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mamta Singh | 5 Founders St, Willimantic, CT 06226 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mamta V Patel | 124 Broad Street, Stamford, CT 06901 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Hajra Shah | Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Dhara K Shah | 61 Royal Dr Apt 216, Piscataway, NJ 08854-3455 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Amit A Shah | 20 York St # 209, New Haven, CT 06512 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Kosha K Shah Dds | 11 Grace St, Fairfield, CT 06825-7415 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Lopa M Shah | 408 New Britain Ave, Hartford, CT 06106-3889 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jai Shah | 34 Park Street, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Hitesh Shah | 80 Seymour St, Hartford, CT 06102 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Ravi Shah | 171 Lake Ave, Colonia, NJ 07067-1354 | Controlled Substance Registration for Practitioner | 2020-04-15 ~ 2021-02-28 |
Please comment or provide details below to improve the information on MAMTA SHAH.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).