SARA J WALLACE PA (Credential# 743442) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
SARA J WALLACE PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001693. The credential type is physician assistant. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 512 Scenic Rd, Orange, CT 06477. The current status is active.
| Licensee Name | SARA J WALLACE PA |
| Credential ID | 743442 |
| Credential Number | 23.001693 |
| Credential Type | Physician Assistant |
| Business Address |
512 Scenic Rd Orange CT 06477 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2005-10-05 |
| Effective Date | 2020-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2020-03-18 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 419555 | CSP.0038472 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2005-10-24 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 512 Scenic Rd |
| City | ORANGE |
| State | CT |
| Zip Code | 06477 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rakesh H Patel Md | 596 Cedar Grove, Orange, CT 06477 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| John D Mainwaring Dds | 240 Indian River Rd, Suite A7, Orange, CT 06477 | Dentist | 2020-08-01 ~ 2021-07-31 |
| Hea Sun Kwak | 477 Howellton Rd, Orange, CT 06477 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-26 ~ 2021-08-31 |
| Munsons Candy Kitchen Inc | 109 Boston Post Rd, Orange, CT 06477 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Takashi Yoshikawa | 151 Old Tavern Road, Orange, CT 06477 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Yam Wong | 21 Country Club Close, Orange, CT 06477 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Shitong Liu | 519 Boston Post Rd Orange, Orange, CT 06477 | Nail Technician | ~ |
| Robert A Lamparski | Po B0x# 1183, Orange, CT 06477 | Real Estate Salesperson | 2019-06-01 ~ 2020-05-31 |
| Rolando R Lopez | 22 Tyler City Rd, Orange, CT 06477 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Lisa Courtney | 470 Locust Drive, Orange, CT 06477 | Notary Public Appointment | 2020-09-01 ~ 2025-08-31 |
| Find all Licenses in zip 06477 | |||
| City | ORANGE |
| Zip Code | 06477 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + ORANGE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Cedric C Wallace IIi | 20 Coolidge Place, Freeport, NY 11520 | Physician Assistant | ~ |
| Nicole M Pillsbury | 102 Wallace Hill Rd, Townsend, MA 01469-1109 | Physician Assistant | 2017-04-01 ~ 2018-03-31 |
| Sara A Mager | 46 Murray Dr, Gorham, ME 04038-4105 | Physician Assistant | 2017-07-01 ~ 2018-06-30 |
| Sara I Kim | 4754 N. Jennys Rd., Indianapolis, IN 46228 | Physician Assistant | 2000-01-12 ~ 2000-10-31 |
| Sara Naseer | 7 Braeburn, Glastonbury, CT 06033-1443 | Physician Assistant | 2020-04-15 ~ 2021-01-31 |
| Sara Graney | 50 Closter Rd, Palisades, NY 10964 | Physician Assistant | 2018-11-20 ~ 2019-07-31 |
| Sara Attia | 140-14 Jewel Ave., Queens, NY 13367 | Physician Assistant | 2019-10-17 ~ 2020-06-30 |
| Sara M Kwon | 115 Paulding St, Fairfield, CT 06824-6609 | Physician Assistant | 2020-02-01 ~ 2021-01-31 |
| Sara J Mester | 403 Earl Ave, New Kensington, PA 15068-4842 | Physician Assistant | 2016-09-01 ~ 2017-08-31 |
| Sara Lewis | 45 Fletcher Ln, Shelburne, VT 05482-7597 | Physician Assistant | 2020-04-19 ~ 2021-04-30 |
Please comment or provide details below to improve the information on SARA J WALLACE PA.
| 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).