AMANDA FANTRY (Credential# 1504869) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 1, 2020. The license expiration date date is August 31, 2021. The license status is ACTIVE.
AMANDA FANTRY is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.061342. The credential type is physician/surgeon. The effective date is September 1, 2020. The expiration date is August 31, 2021. The business address is 1000 Asylum Ave, Hartford, CT 06105-1770. The current status is active.
Licensee Name | AMANDA FANTRY |
Credential ID | 1504869 |
Credential Number | 1.061342 |
Credential Type | Physician/Surgeon |
Business Address |
1000 Asylum Ave Hartford CT 06105-1770 |
Business Type | INDIVIDUAL |
Status | ACTIVE - CURRENT |
Active | 1 |
Issue Date | 2018-06-08 |
Effective Date | 2020-09-01 |
Expiration Date | 2021-08-31 |
Refresh Date | 2020-06-08 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
1523450 | CSP.0068666 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-06-13 | 2019-03-01 - 2021-02-28 | ACTIVE |
Street Address | 1000 ASYLUM AVE |
City | HARTFORD |
State | CT |
Zip Code | 06105-1770 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Malta House of Care, Inc. · Malta House of Care Mobile Medicial Clinic | 1000 Asylum Ave, Hartford, CT 06105-1770 | Outpatient Clinic | 2019-08-02 ~ 2022-06-30 |
Luis F Diez-morales | 1000 Asylum Ave, Hartford, CT 06105 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
H Robert Silverstein | 1000 Asylum Ave, Hartford, CT 06105-1794 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Peter P White | 1000 Asylum Ave, Hartford, CT 06105 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Bechara Barrak Md | 1000 Asylum Ave, Hartford, CT 06105 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Malta House of Care, Inc.-st. Peter's Church | 1000 Asylum Ave, Hartford, CT 06105-1770 | Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
Martin Hoffman Do | 1000 Asylum Ave, Hartford, CT 06105 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
Eugene D Sullivan | 1000 Asylum Ave, Hartford, CT 06105 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
James M Feeney Md · A Proof of Concept, Open Label Prospective Pilot Study of Cannabis Use In Trauma Patients With Multiple Rib Fractures. | 1000 Asylum Ave, Hartford, CT 06105-1770 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Aileen Pangilinan | 1000 Asylum Ave, Hartford, CT 06105 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Find all Licenses in the same address |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Vincent M Varilla | 1000 Asylum Ave Ste 1025, Hartford, CT 06105-1770 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Hartford Community Loan Fund | 215 Garden Street, Hartford, CT 06105 | Public Charity | 2019-06-01 ~ 2020-05-31 |
Kathleen C Hobart | 81 Fern Street, Hartford, CT 06105 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
Khadija Seidi | 196 Laurel St, Hartford, CT 06105 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
Stuart W Alpert | 200 N Beacon St, Hartford, CT 06105 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
Christina Perez | 4 Atwood Street, Hartford, CT 06105 | Marital and Family Therapist | 2020-07-01 ~ 2021-06-30 |
Ashley Ameena Bachan | 25 Owen Street, Hartford, CT 06105 | Licensed Practical Nurse | 2020-06-01 ~ 2021-05-31 |
Dhruti Anilkant Mankodi | Hospitalist Department, Hartford, CT 06105 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
Jacqueline Alexandra Raymond | 24 Owen Street, Hartford, CT 06105 | Esthetician | 2020-06-22 ~ 2021-10-31 |
Hortense Bates | 48-50 Atwood Street, Hartford, CT 06105 | Medication Administration Certification | 2020-08-20 ~ 2022-08-19 |
Nicolas Archambault | 169 Sigourney Street, Hartford, CT 06105 | Emergency Medical Technician | ~ |
Find all Licenses in zip 06105 |
City | HARTFORD |
Zip Code | 06105 |
License Type | Physician/Surgeon |
License Type + County | Physician/Surgeon + HARTFORD |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Amanda S. Cuda | 701 5th Ave, Seattle, WA 98104 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
Amanda R Ganem Md | 1 Theall Rd, Rye, NY 10580 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Amanda M. Hedges | 852 Us Highway 1, Edison, NJ 08817 | Physician/surgeon | 2019-07-01 ~ 2020-06-30 |
Amanda L Conti Md | 9 Piezzo Dr, Westerly, RI 02891 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Amanda L. Wilson | 46 Sovereign Way, Florence, MA 01062-9615 | Physician/surgeon | 2016-11-01 ~ 2017-10-31 |
Amanda Medoro | 54 Republic Dr Apt 111, Bloomfield, CT 06002-5444 | Physician/surgeon | 2016-05-01 ~ 2017-04-30 |
Amanda Ramos | 110 Beverly St Apt 636, Boston, MA 02114-2257 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
Amanda M Meulenberg Md | 12 Avery Pl, Westport, CT 06880-3223 | Physician/surgeon | 2019-01-01 ~ 2019-12-31 |
Amanda Stein Carmel | 437 Melbourne Ave, Mamaroneck, NY 10543-2730 | Physician/surgeon | ~ |
Amanda Collins-baine Md | 53 Old Kings Hwy N Ste 205, Darien, CT 06820-4735 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
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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).