SREELAKSHMI REDDIVARI (Credential# 1049886) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2020. The license expiration date date is June 30, 2021. The license status is ACTIVE.
SREELAKSHMI REDDIVARI is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.002736. The credential type is physician assistant. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 17 Shady Brook Dr, West Hartford, CT 06107-2654. The current status is active.
| Licensee Name | SREELAKSHMI REDDIVARI |
| Credential ID | 1049886 |
| Credential Number | 23.002736 |
| Credential Type | Physician Assistant |
| Business Address |
17 Shady Brook Dr West Hartford CT 06107-2654 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2012-03-07 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-04-16 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1056490 | CSP.0052143 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2012-03-21 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 848658 | 70.008925 | Emergency Medical Technician | 2007-10-15 | 2007-10-15 - 2009-03-31 | INACTIVE |
| 1056489 | CSM.0000433-OOS | OUT OF STATE MANUFACTURER OF DRUGS, COSMETICS & MEDICAL DEVICES | - | PENDING |
| Street Address | 17 SHADY BROOK DR |
| City | WEST HARTFORD |
| State | CT |
| Zip Code | 06107-2654 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rebecca L Stansfield | 73 Tunxis Road, West Hartford, CT 06107 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Kumari Joshi | 44 Bentwood Rd, West Hartford, CT 06107 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Laurie C Caines Md | 205 Stoner Drive, West Hartford, CT 06107 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Nicole K. Edlund | 11 Greenacres Avenue, West Hartford, CT 06107 | Master's Level Social Worker - Temporary Permit | ~ |
| Andrea M Yuliano | 39 Mountain Terrace Road, West Hartford, CT 06107 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Elizabeth M Ineson | 4 Linwold Dr, West Htfd, CT 06107 | Architect | 2020-08-01 ~ 2021-07-31 |
| Sarah G Potter | 19 Westland Ave, West Hartford, CT 06107 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Jessica C Abreu | 14 Deepwood Lane, West Hartford, CT 06107 | Real Estate Salesperson | 2020-06-18 ~ 2021-05-31 |
| William C Richter | 67 Hillsboro Drive, West Hartford, CT 06107 | Architect | 2020-08-01 ~ 2021-07-31 |
| Teresa M Stanton | 25 Common Dr., West Hartford, CT 06107 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06107 | |||
| City | WEST HARTFORD |
| Zip Code | 06107 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + WEST HARTFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Physician Assistant Foundation of The American Academy of Physician Assistants | 2318 Mill Rd Ste 1300, Alexandria, VA 22314-6868 | Public Charity | 2019-12-01 ~ 2020-11-30 |
| Theresa V Horvath | Physiican Assistant Institute, Bridgeport, CT 06604 | Physician Assistant | 2018-10-01 ~ 2019-09-30 |
| Quinnipiac University Physician Assistant Student Society | 370 Bassett Rd, North Haven, CT 06473-4201 | Raffle Permit Class 1 | 2017-01-12 ~ 2017-04-08 |
| Connecticut Dermatology Physician Assistant Society Inc. | Po Box 847, Manchester, CT 06045 | Public Charity-exempt From Financial Requirements | ~ |
| Gretchen Treves | Physician One Urgent Care, Brookfield, CT 06804 | Physician Assistant | ~ |
| James H Brown | 11-c Cos Cob Ave, Cos Cob, CT 06807 | Physician Assistant | 2005-11-15 ~ 2006-11-30 |
| Mia F Williams | 3 Old Oak Rd, Norwich, CT 06360-1500 | Physician Assistant | 2020-08-01 ~ 2021-07-31 |
| L. Katherine Grasso | Po Box 191, Sudbury, MA 01776-0191 | Physician Assistant | ~ |
| Stacey Rydzewska | 421 S End Rd, Plantsville, CT 06479 | Physician Assistant | ~ |
| Stacie Meisner | Po Box 384, Albion, RI 02802-0384 | Physician Assistant | ~ |
Please comment or provide details below to improve the information on SREELAKSHMI REDDIVARI.
| 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).