MICHAEL BRODY O'SULLIVAN (Credential# 1469965) 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 INACTIVE.
MICHAEL BRODY O'SULLIVAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0067307. 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 263 Farmington Ave, Farmington, CT 06030-0001. The current status is inactive.
| Licensee Name | MICHAEL BRODY O'SULLIVAN |
| Credential ID | 1469965 |
| Credential Number | CSP.0067307 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
263 Farmington Ave Farmington CT 06030-0001 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LACK OF ACTIVE MEDICAL LICENSE |
| Issue Date | 2018-05-07 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-04-20 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1511711 | 1.060642-RES | Resident Physician | 2013-07-01 | 2013-07-01 - 2018-07-27 | INACTIVE |
| Street Address | 263 FARMINGTON AVE |
| City | FARMINGTON |
| State | CT |
| Zip Code | 06030-0001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Erica Shen Nofziger | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2027-06-30 |
| Matthew D Goranson | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2026-06-30 |
| Jacob Silver | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Nicholas Bellas | 263 Farmington Ave, Farmington, CT 06032-1956 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Jennifer Hale | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Cory R Hewitt | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Sango Huwaa Mosia Asante | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Ryan Desrochers | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Kelsey D Greenhalgh | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Dentist | 2019-07-01 ~ 2025-06-30 |
| Derek J Tow | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Dentist | 2019-07-01 ~ 2025-06-30 |
| Find all Licenses in the same address | |||
| 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 |
| 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 |
| Angela Hart | General Medicine- Outpatient Pavilion, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 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 |
|---|---|---|---|
| Michael C Sullivan | 38 Crown St, New Haven, CT 60510 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Michael W Martin Md | 1504 Sullivan Ave, S Windsor, CT 06074 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Amber Brody | 249 Danbury Rd, Wilton, CT 06897-4010 | Controlled Substance Registration for Practitioner | 2019-07-25 ~ 2021-02-28 |
| Oren Brody | 22 Cheshire Dr, Longmeadow, MA 01106-2133 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Steven M Brody | 23 Maple Ave, Greenwich, CT 06830 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Brody A Flanagin | 432 Central Avenue #3, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Karen H Brody Md | 2435 Bedford Street, Stamford, CT 06905-3934 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard L Brody Md | St. Francis Emergency Medical Group, Hartford, CT 06105 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Len Jd Sullivan | Po Box 5, Somers, CT 06071-0005 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Danielle L Kempesta | 104 Sullivan Rd, Lisbon, CT 06351 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 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).