NICOLE S FEAGIN (Credential# 1300856) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
NICOLE S FEAGIN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.003433. The credential type is physician assistant. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 30 Shelburne Rd, Stamford, CT 06902-3628. The current status is active.
| Licensee Name | NICOLE S FEAGIN |
| Credential ID | 1300856 |
| Credential Number | 23.003433 |
| Credential Type | Physician Assistant |
| Business Address |
30 Shelburne Rd Stamford CT 06902-3628 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2015-09-28 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-04-29 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1314116 | CSP.0061536 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2015-09-30 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 30 SHELBURNE RD |
| City | STAMFORD |
| State | CT |
| Zip Code | 06902-3628 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Randall D Grant | 30 Shelburne Rd, Stamford, CT 06902-3628 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Tracy Shevell Md | 30 Shelburne Rd, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Hebroon Obaid | 30 Shelburne Rd, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Shelley Smith Tickett | 30 Shelburne Rd, Stamford, CT 06902-3628 | Physician/surgeon | 2018-04-01 ~ 2019-03-31 |
| Michelle R Maly | 30 Shelburne Rd, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2017-04-21 ~ 2019-02-28 |
| Diana M Bernal-messinger Aprn | 30 Shelburne Rd, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2017-04-20 ~ 2019-02-28 |
| Molly Findley | 30 Shelburne Rd, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Maureen C Burke | 30 Shelburne Rd, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Jennifer Cabral | 30 Shelburne Rd, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2015-03-23 ~ 2017-02-28 |
| Elizabeth M Rodriguez | 30 Shelburne Rd, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Marcos Valerio | 1 Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-06 ~ 2021-02-28 |
| Antonia L Green | 1 Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| John F Ciannella Md | One Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Sasha Cobotic | 1 Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Dmitry Meyerovich | 1 Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Arunabha Nandi | 1 Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Julianne M Wilmot | 1 Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kamal Addagatla | Department of Surgery, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Chao Guo | 59 Liberty Street, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Basil N Waoz | 1 Hospital Plaza, Stamford, CT 06902-3628 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Find all Licenses in zip 06902-3628 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jeris Maydeli Flores | 153 Fairfield Av, Stamford, CT 06902 | Nail Technician | ~ |
| Reynaldo De La Cruz | 64 Brookside Drive, Stamford, CT 06902 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Darren J Petillo | 5 Hundley Court, Stamford, CT 06902 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| Antonios Restaurant | 405 West Main St, Stamford, CT 06902 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Edward Smith | 184 Fairfield Ave., Stamford, CT 06902 | Home Improvement Contractor | ~ |
| Margaret A Dorrance | 24c Hamilton Court, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Carolyn Maguire | 48 Nelson St, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Evelyne Joassin | 17 George St., Stamford, CT 06902 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Andrea Bynoe | 34 Melrose Pl, Stamford, CT 06902 | Notary Public Appointment | 1994-04-06 ~ 1999-04-30 |
| Ravi K Ahuja | 296 Westover Rd, Stamford, CT 06902 | Architect | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06902 | |||
| City | STAMFORD |
| Zip Code | 06902 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + STAMFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nicole R Ciccia | 71 Joy Rd Apt C, Milford, CT 06460-6052 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Courtney Nicole Enos | 916 1/2 4th St Ne, Byron, MN 55920-1530 | Physician Assistant | ~ |
| Nicole D Greco Pa | 604 Tompkins Ave Apt B5, Mamaroneck, NY 10543-3729 | Physician Assistant | 2015-03-01 ~ 2016-02-29 |
| Ashley Nicole Hiep | 3 Sgt. Demeola Rd., Blauvelt, NY 10913 | Physician Assistant | ~ |
| Jaime A Camacho | 6 Nicole Ln, Burlington, CT 06013-2123 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Nicole Ferrantelli | 59 Old Post Rd Apt F7, Clinton, CT 06413-1864 | Physician Assistant | 2010-07-01 ~ 2011-06-30 |
| Nicole M Esposito | 5 Lexington Ct, Shelton, CT 06484-5961 | Physician Assistant | 2020-08-01 ~ 2021-07-31 |
| Nicole Ann Dietzel | 94 Hawthorne Dr, Southington, CT 06489-2818 | Physician Assistant | 2020-09-01 ~ 2021-08-31 |
| Nicole M Spataro | 427 Williams Rd, Wallingford, CT 06492-2690 | Physician Assistant | 2018-11-01 ~ 2019-10-31 |
| Colleen Nicole Durkee | 345 Laurelwood Dr, Salem, CT 06420-3931 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
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| 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).