TANEYA C SHESTOPALOVA (Credential# 1163643) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is December 19, 2018. The license expiration date date is February 28, 2019. The license status is INACTIVE.
TANEYA C SHESTOPALOVA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.052120. The credential type is physician/surgeon. The effective date is December 19, 2018. The expiration date is February 28, 2019. The business address is 5627 Blackstone Dr, Temple, TX 76502-1145. The current status is inactive.
| Licensee Name | TANEYA C SHESTOPALOVA |
| Credential ID | 1163643 |
| Credential Number | 1.052120 |
| Credential Type | Physician/Surgeon |
| Business Address |
5627 Blackstone Dr Temple TX 76502-1145 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2013-06-19 |
| Effective Date | 2018-12-19 |
| Expiration Date | 2019-02-28 |
| Refresh Date | 2019-06-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1260573 | CSP.0059166 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2015-01-13 | 2017-03-01 - 2019-02-28 | LAPSED |
| Street Address | 5627 BLACKSTONE DR |
| City | TEMPLE |
| State | TX |
| Zip Code | 76502-1145 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kathleen J Silva | 6302 Ambrose Circle, Temple, TX 76502 | Licensed Practical Nurse | 2019-08-01 ~ 2020-07-31 |
| Kristina Daniella Heath | 321 Big Timber, Temple, TX 76502 | Registered Nurse - Temporary | 2018-11-28 ~ 2019-03-28 |
| Mija H Coles Md | 3305 Cordova Drive, Temple, TX 76502 | Physician/surgeon | 2015-06-01 ~ 2016-05-31 |
| Mary J Kirchhoff | 4000 Hickory Rd #3, Temple, TX 76502 | Massage Therapist | ~ |
| Unique Pharmaceuticals | 5920 South General Bruce Drive, Temple, TX 76502 | Nonresident Pharmacy | 2013-09-01 ~ 2014-08-31 |
| Linda M Chichester | 4206 Wren Rd, Temple, TX 76502 | Registered Nurse | 1998-01-12 ~ 1999-01-31 |
| Theresa M Becker | 11408 Somerville Dr, Temple, TX 76502 | Physician/surgeon | 1998-09-11 ~ 1999-08-31 |
| Mary Jo S Koss | 2912 Timber Ridge Drive, Temple, TX 76502 | Registered Nurse | 2001-06-04 ~ 2002-06-30 |
| Justin T Hunt | 69 Silo Way, Bloomfield, TX 76502 | Controlled Substance Registration for Practitioner | 2013-07-23 ~ 2015-02-28 |
| Hang T. Vu | Apt 107, Temple, TX 76502 | Physician/surgeon | 2010-10-01 ~ 2011-09-30 |
| Find all Licenses in zip 76502 | |||
| City | TEMPLE |
| Zip Code | 76502 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + TEMPLE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Taneya J Hill | 191 Pleasantview Ave, Bridgeport, CT 06606-3767 | Off Track Betting Facility Employee | 2017-06-28 ~ 2017-12-31 |
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
| John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Sajot S Grewal Md | Danbury Office of Physician Services PC, Danbury, CT 06810 | Physician/surgeon | 2004-01-30 ~ 2005-03-31 |
Please comment or provide details below to improve the information on TANEYA C SHESTOPALOVA.
| 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).