SHANNON B WIDDERICK PA
Controlled Substance Registration for Practitioner


Address: 354 Birnie Ave, Springfield, MA 01107-1108

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.

Business Overview

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.

Basic Information

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

Other licenses

ID Credential Code Credential Type Issue Term Status
743741 23.001992 Physician Assistant 2007-10-09 2008-09-09 - 2009-06-30 INACTIVE

Office Location

Street Address 354 BIRNIE AVE
City SPRINGFIELD
State MA
Zip Code 01107-1108

Licenses in the same location

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

Licenses in the same zip code

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

Licenses in the same zip code

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

Competitor

Search similar business entities

City SPRINGFIELD
Zip Code 01107
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + SPRINGFIELD

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Shannon A Watkins 64 Robbins St, Waterbury, CT 06708-2613 Controlled Substance Registration for Practitioner 2009-07-28 ~ 2011-02-28
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Dataset Information

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).

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