AMANDA M MEULENBERG MD (Credential# 565065) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is January 1, 2019. The license expiration date date is December 31, 2019. The license status is INACTIVE.
AMANDA M MEULENBERG MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.047483. The credential type is physician/surgeon. The effective date is January 1, 2019. The expiration date is December 31, 2019. The business address is 12 Avery Pl, Westport, CT 06880-3223. The current status is inactive.
Licensee Name | AMANDA M MEULENBERG MD |
Credential ID | 565065 |
Credential Number | 1.047483 |
Credential Type | Physician/Surgeon |
Business Address |
12 Avery Pl Westport CT 06880-3223 |
Business Type | INDIVIDUAL |
Status | INACTIVE - LAPSED DUE TO NON-RENEWAL; PRIOR DISCIPLINE |
Issue Date | 2009-03-24 |
Effective Date | 2019-01-01 |
Expiration Date | 2019-12-31 |
Refresh Date | 2020-06-08 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
529750 | CSP.0045354 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2009-04-09 | 2017-03-01 - 2019-02-28 | LAPSED |
Street Address | 12 AVERY PL |
City | WESTPORT |
State | CT |
Zip Code | 06880-3223 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Elizabeth Nadal | 12 Avery Pl, Westport, CT 06880 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Nikko Dunlevy | 12 Avery Pl, Westport, CT 06880-3223 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Marjorie Szeto Md | 12 Avery Pl, Westport, CT 06880-3223 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Toni L Bucker | 4 Wild Rose Rd, Westport, CT 06880 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
Jee Hyun Kim | 1 Allen Lane, Westport, CT 06880 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-26 ~ 2021-07-31 |
Donna Vaccarella | 15 Keyser Rd, Westport, CT 06880 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
Sandra Gibson | 12 Bayberry Ln, Westport, CT 06880 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
Adil Salam Md | 44 Crawford Rd, Westport, CT 06880 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
Joanne C Sosnoski | 24 Hawatha Lane, Westport, CT 06880 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
Rachel Lynn | 495 Post Rd East, Westport, CT 06880 | Eyelash Technician | ~ |
Beginnings: An Infant/toddler Program | 71 Hillandale Road, Westport, CT 06880 | Group Child Care Home | 2018-01-01 ~ 2021-12-31 |
Shelley S Ross | 28 Old Hill Farms Rd, Westport, CT 06880 | Dietitian/nutritionist | 2020-08-01 ~ 2021-07-31 |
Robert W Van Summern | 279 Wilton Rd, Westport, CT 06880 | Architect | 2020-08-01 ~ 2021-07-31 |
Find all Licenses in zip 06880 |
City | WESTPORT |
Zip Code | 06880 |
License Type | Physician/Surgeon |
License Type + County | Physician/Surgeon + WESTPORT |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Amanda R Ganem Md | 1 Theall Rd, Rye, NY 10580 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Amanda S. Cuda | 701 5th Ave, Seattle, WA 98104 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
Amanda Ramos | 110 Beverly St Apt 636, Boston, MA 02114-2257 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
Amanda Medoro | 54 Republic Dr Apt 111, Bloomfield, CT 06002-5444 | Physician/surgeon | 2016-05-01 ~ 2017-04-30 |
Amanda L Conti Md | 9 Piezzo Dr, Westerly, RI 02891 | 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. Wilson | 46 Sovereign Way, Florence, MA 01062-9615 | Physician/surgeon | 2016-11-01 ~ 2017-10-31 |
Amanda Stein Carmel | 437 Melbourne Ave, Mamaroneck, NY 10543-2730 | Physician/surgeon | ~ |
Amanda J Russell-kleiner | 41 Bronson Mtn, Roxbury, CT 06783-2126 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
Amanda B Dill | 24 Hospital Avenue, Danbury, CT 06810 | Physician/surgeon | 2005-06-13 ~ 2006-07-31 |
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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).