SHELLEY SMITH TICKETT (Credential# 1378857) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2018. The license expiration date date is March 31, 2019. The license status is INACTIVE.
SHELLEY SMITH TICKETT is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.055824. The credential type is physician/surgeon. The effective date is April 1, 2018. The expiration date is March 31, 2019. The business address is 30 Shelburne Rd, Stamford, CT 06902-3628. The current status is inactive.
| Licensee Name | SHELLEY SMITH TICKETT |
| Credential ID | 1378857 |
| Credential Number | 1.055824 |
| Credential Type | Physician/Surgeon |
| Business Address |
30 Shelburne Rd Stamford CT 06902-3628 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2016-10-13 |
| Effective Date | 2018-04-01 |
| Expiration Date | 2019-03-31 |
| Refresh Date | 2019-07-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1378975 | CSP.0064035 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2016-10-13 | 2016-10-14 - 2017-02-28 | INACTIVE |
| Street Address | 30 SHELBURNE RD |
| City | STAMFORD |
| State | CT |
| Zip Code | 06902-3628 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nicole S Feagin | 30 Shelburne Rd, Stamford, CT 06902-3628 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| 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 |
| 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/Surgeon |
| License Type + County | Physician/Surgeon + STAMFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Shelley Berson | 106 Mcintosh Dr, Mahwah, NJ 07430-3206 | Physician/surgeon | 2016-03-01 ~ 2017-02-28 |
| Shelley L Goodstine | 993 Patricia Ct, Orange, CT 06477-1053 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Shelley N Weiner | 31 Crestview Dr, Pleasantville, NY 10570-1426 | Physician/surgeon | 2015-09-01 ~ 2016-08-31 |
| Gabriela Shelley | 306 Audubon Court, New Haven, CT 06510 | Physician/surgeon | 1993-01-25 ~ 1994-02-28 |
| Kirk H Shelley Md | 86 Kohary Drive, New Haven, CT 06515 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Shelley L Amen | Va Ct Healthcare System, West Haven, CT 06516 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Joel Canter | 8 Shelley Hill Road, Stanfordville, NY 12581 | Physician/surgeon | 2010-12-01 ~ 2011-11-30 |
| Shelley P Wood · Shelley's Painting | 120 Hangman Hill Road, N Stonington, CT 06359 | Home Improvement Contractor | 2019-12-19 ~ 2020-11-30 |
| Jennifer L Yeh Md | 4 Smith Dr, Savannah, GA 31406-6441 | Physician/surgeon | 2012-12-01 ~ 2013-11-30 |
| Ben Ten | 52 Smith Farm Rd, Amston, CT 06231-1241 | Physician/surgeon | 2011-09-27 ~ 2012-03-31 |
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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).