RORY M SHALLIS (Credential# 1490981) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2017. The license expiration date date is June 30, 2021. The license status is ACTIVE.
RORY M SHALLIS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.059083-RES. The credential type is resident physician. The effective date is July 1, 2017. The expiration date is June 30, 2021. The business address is 343 Elmgrove Ave, Providence, RI 02906-4251. The current status is active.
| Licensee Name | RORY M SHALLIS |
| Credential ID | 1490981 |
| Credential Number | 1.059083-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
343 Elmgrove Ave Providence RI 02906-4251 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2017-07-01 |
| Effective Date | 2017-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-05-27 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1420051 | CSP.0065250 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2017-06-12 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 343 ELMGROVE AVE |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02906-4251 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| The Stephen C. Rose Legacy Foundation · The Steve Fund | 138 Governor Street, Providence, RI 02906 | Public Charity | 2020-06-12 ~ 2021-11-30 |
| Moriah Connor | 211 Waterman Street, Unit 20, Providence, RI 02906 | Behavior Analyst | ~ |
| Elizabeth Burns | 198 Camp Street, Providence, RI 02906 | Licensed Clinical Social Worker | ~ |
| Christine Montross | 345 Blackstone Blvd, Providence, RI 02906 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Susan Dickstein | 196 Freeman Parkway, Providence, RI 02906 | Psychologist | 2020-07-01 ~ 2021-06-30 |
| Victoria S Karlsen | 415 Angell St, Providence, RI 02906 | Behavior Analyst | ~ |
| John W O'bell Md | 14 Rose Ct., Providence, RI 02906 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Alexandria Hanul Simon | 323 Angell Street, Providence, RI 02906 | Emergency Medical Technician | ~ |
| Molly A Moran | 202 Sixth Street, Providence, RI 02906 | Advanced Practice Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Simon M Cornelissen | 45 Balton Rd, Providence, RI 02906 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Find all Licenses in zip 02906 | |||
| City | PROVIDENCE |
| Zip Code | 02906 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + PROVIDENCE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rory Michael Shallis | 333 Cedar St, New Haven, CT 06510-3206 | Physician/surgeon | 2020-04-23 ~ 2021-04-30 |
| Patrick R Donahue · Rory's | 2316 Post Road, Fairfield, CT 06430 | Restaurant Liquor | 2006-08-17 ~ 2007-08-16 |
| Rory Mccrimmon · Yale University Oehs | 135 College St 1st Flr, New Haven, CT 06510 | Controlled Substance Laboratory | 2009-03-19 ~ 2010-01-31 |
| Rory Tropp | 2518 Partridge Dr, Pittsburgh, PA 15241-2822 | Physician/surgeon | 2016-06-01 ~ 2017-05-31 |
| Rory C Byrne | 12606 Golden Oak Dr, Ellicott City, MD 21042 | Physician/surgeon | 1994-10-31 ~ 1995-10-31 |
| Tammy J Shallis | 145 Settlers Ridge Rd, Milford, CT 06460 | Registered Nurse | 2020-02-01 ~ 2021-01-31 |
| Carl Shallis | 101-7 Ridge Road, Naugatuck, CT 06770 | Vending Machine Operator | 2005-07-01 ~ 2006-06-30 |
| Joyce T Shallis | 264 Shadyside Lane, Milford, CT 06460 | Licensed Clinical Social Worker | 2013-03-01 ~ 2014-02-28 |
| The Rory Staunton Foundation for Sepsis Prevention | 135 W 50th St, New York, NY 10020-1201 | Public Charity-exempt From Financial Requirements | 2019-11-08 ~ |
| Jin Woo Yoo | 44 Orange St Apt 317, New Haven, CT 06510 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
Please comment or provide details below to improve the information on RORY M SHALLIS.
| 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).