KELLY B FEDORIW MD (Credential# 441165) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2008. The license expiration date date is February 28, 2009. The license status is INACTIVE.
KELLY B FEDORIW MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0039319. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2008. The expiration date is February 28, 2009. The business address is 756 Quinnipiac Ave, New Haven, CT 06513. The current status is inactive.
| Licensee Name | KELLY B FEDORIW MD |
| Credential ID | 441165 |
| Credential Number | CSP.0039319 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
756 Quinnipiac Ave New Haven CT 06513 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE |
| Issue Date | 2006-06-14 |
| Effective Date | 2008-03-01 |
| Expiration Date | 2009-02-28 |
| Refresh Date | 2011-01-12 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 561952 | 1.044370 | Physician/Surgeon | 2006-05-16 | 2007-11-23 - 2009-01-31 | INACTIVE |
| Street Address | 756 QUINNIPIAC AVE |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06513 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Richard S. Adams | 756 Quinnipiac Ave, New Haven, CT 06513 | Crane Operator Apprentice | 2010-09-16 ~ 2012-09-15 |
| George D Fedoriw | 756 Quinnipiac Ave, New Haven, CT 06513 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Odalys Guartan | 17 Dell Dr, East Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2022-06-30 |
| Marilu E Espinsa | 148 Poplar St, New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Javon Christian Woodard | 404 Poplar St, New Haven, CT 06513 | Registered Nurse | ~ |
| Norma Congacha | 22 Farren Ave., New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2022-05-31 |
| Sonia Sunanita Salazar | 48 Wolcott St 1 L., New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Rosa Zuna | 426 Ferry St. 1st Fl, New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Veronica Congacha | 28 Farren Ave., New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Jessica L Vallejo | 41 Oak Ridge Dr, New Haven, CT 06513 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-26 ~ 2022-02-28 |
| Ami Nosenzo · Nosenzo | 1423 Quinnipiac Ave, New Haven, CT 06513 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Taquetta Delis Mitchell | 40 Foxon Hill Rd I34, New Haven, CT 06513 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06513 | |||
| City | NEW HAVEN |
| Zip Code | 06513 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + NEW HAVEN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| George D Fedoriw | 756 Quinnipiac Ave, New Haven, CT 06513 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Kelly Gullotta | Po Box 465, Brownsville, VT 05037-0465 | Controlled Substance Registration for Practitioner | 2020-04-09 ~ 2021-02-28 |
| Kelly M Ferjentsik | 34 Little Fox Ln, Monroe, CT 06468-1607 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kelly M. Doran Md | New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Kelly M Deforest | 267 Rte 87, Columbia, CT 06237 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kelly J Way | 34 B Springbrook Rd, Westerly, RI 02891 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kelly Ann Sullivan Aprn | 6 Fox Run, Wilton, CT 06897 | Controlled Substance Registration for Practitioner | 2019-03-21 ~ 2021-02-28 |
| Margaret Kelly Md | 15 Red Orange Rd, Middletown, CT 06457 | Controlled Substance Registration for Practitioner | 2004-02-29 ~ 2005-02-28 |
| Paul R Kelly D.o. | 761 Main Ave Ste 201, Norwalk, CT 06851-1005 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kelly Damon | 47 Eckert Rd, Newington, CT 06111-4903 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on KELLY B FEDORIW MD.
| 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).