SHANNON B WIDDERICK PA (Credential# 486905) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2011. The license expiration date date is February 28, 2013. The license status is INACTIVE.
SHANNON B WIDDERICK PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0042805. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2011. The expiration date is February 28, 2013. The business address is 354 Birnie Ave, Springfield, MA 01107-1108. The current status is inactive.
Licensee Name | SHANNON B WIDDERICK PA |
Credential ID | 486905 |
Credential Number | CSP.0042805 |
Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
Business Address |
354 Birnie Ave Springfield MA 01107-1108 |
Business Type | INDIVIDUAL |
Status | INACTIVE |
Issue Date | 2007-10-31 |
Effective Date | 2011-03-01 |
Expiration Date | 2013-02-28 |
Refresh Date | 2014-01-29 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
743741 | 23.001992 | Physician Assistant | 2007-10-09 | 2008-09-09 - 2009-06-30 | INACTIVE |
Street Address | 354 BIRNIE AVE |
City | SPRINGFIELD |
State | MA |
Zip Code | 01107-1108 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
David M. Robertson | 354 Birnie Ave, Springfield, MA 01107-1108 | Physician/surgeon | 2014-08-01 ~ 2015-07-31 |
Jonathan L Bayuk | 354 Birnie Ave, Springfield, MA 01107-1108 | Controlled Substance Registration for Practitioner | 2012-12-05 ~ 2015-02-28 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Brittany Chew | 354 Birnie Ave Fl 1, Springfield, MA 01107-1108 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Lauren Elizabeth Marshall | 945 Armory St, Springfield, MA 01107 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
Jennifer L Fish | 367 Union Street, Springfield, MA 01107 | Hairdresser/cosmetician | ~ |
Joseph Pagan | 59 Rowland Street, Springfield, MA 01107 | Medication Administration Certification | 2020-04-20 ~ 2022-04-19 |
Daniel Laguerre | 382 Springfield St, Springfield, MA 01107 | Crane Operator | ~ |
Kamal Kant Kalia | 2 Medical Center Drive, Springfield, MA 01107 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
Bushee Enterprises LLC | Po Box 1196, Southwick, MA 01107 | Home Improvement Contractor | 2015-12-01 ~ 2016-11-30 |
B Lopez | 165 Prospect Street, Springfield, MA 01107 | Notary Public Appointment | 2011-10-01 ~ 2016-09-30 |
Beth C Mcinerny | 260 Ware Road, Belchertown, MA 01107 | Registered Nurse | 2019-12-01 ~ 2020-11-30 |
Jorge Enrique Rivera | 20 Narragansett Street, Springfield, MA 01107 | Professional Counselor | 2019-10-01 ~ 2020-09-30 |
Rachael Hynds-decoteau | 22 Candice Cir, Springfield, MA 01107 | Controlled Substance Registration for Practitioner | 2019-09-19 ~ 2021-02-28 |
Find all Licenses in zip 01107 |
City | SPRINGFIELD |
Zip Code | 01107 |
License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + SPRINGFIELD |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Shannon S Maher | 16 Cat Rock Rd, Cos Cob, CT 06807-1704 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
Shannon L Degroff | 11 Acre Way, Southington, CT 06489-2253 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Shannon P Martinello Md | 1 Bradley Rd Ste 102, Woodbridge, CT 06525-2235 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Shannon D Hall | 640 Urlacher Dr, Murfreesboro, TN 37129-8998 | Controlled Substance Registration for Practitioner | 2010-02-04 ~ 2019-02-28 |
Shannon L Oteri | 282 Washington St, Hartford, CT 06106-3322 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
Shannon Sullivan | 41 Brewster Rd, Bristol, CT 06010-5161 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
Shannon M Bertolino Dvm | 31 Gracey Rd, Canton, CT 06019-2471 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Shannon E Demas | 242 S. Whitney St., Hartford, CT 06105 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
Shannon A Watkins | 64 Robbins St, Waterbury, CT 06708-2613 | Controlled Substance Registration for Practitioner | 2009-07-28 ~ 2011-02-28 |
Shannon M Marcotte Do | 71 Haynes St, Manchester, CT 06040 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
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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).