LATHA ANEKONDADHA REVAKALA (Credential# 1238845) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2020. The license expiration date date is June 30, 2021. The license status is APPROVED.
LATHA ANEKONDADHA REVAKALA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.003173. The credential type is physician assistant. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 20 Montoya Dr Unit 21, Branford, CT 06405-2534. The current status is approved.
Licensee Name | LATHA ANEKONDADHA REVAKALA |
Credential ID | 1238845 |
Credential Number | 23.003173 |
Credential Type | Physician Assistant |
Business Address |
20 Montoya Dr Unit 21 Branford CT 06405-2534 |
Business Type | INDIVIDUAL |
Status | APPROVED - CURRENT |
Active | 1 |
Issue Date | 2014-08-28 |
Effective Date | 2020-07-01 |
Expiration Date | 2021-06-30 |
Refresh Date | 2020-06-25 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
1242871 | CSP.0058632 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2014-09-22 | 2019-03-01 - 2021-02-28 | ACTIVE |
Street Address | 20 MONTOYA DR UNIT 21 |
City | BRANFORD |
State | CT |
Zip Code | 06405-2534 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Martin Buonfiglin Jr | 18 Montoya Dr, Branford, CT 06405-2534 | Home Improvement Salesperson | 2019-12-20 ~ 2020-11-30 |
Courtney Elizabeth Mcauliffe | 14 Montoya Dr, Branford, CT 06405-2534 | Certified Public Accountant License | 2019-12-13 ~ 2020-12-31 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Raymond M Johnson | 39 Bayberry Lane, Branford, CT 06405 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
Kirsten M Ranciato | 288 East Main Street, Branford, CT 06405 | Licensed Clinical Social Worker | 2020-08-01 ~ 2021-07-31 |
Bimala Khadka Thapa | 726 Robert Frost Dr., Branford, CT 06405 | Nail Technician | ~ |
Paul E Basile | 42 Valley Brook Road South, Branford, CT 06405 | Perfusionist | 2020-08-01 ~ 2021-07-31 |
Lupe Monica Placencia-muy | 100 East Main Street 2nd Fl, Branford, CT 06405 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2022-02-28 |
Bridget J Jennings | 159 Queach Road, Branford, CT 06405 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
Ujeli Acharya | 21 Burban Drive, Branford, CT 06405 | Nail Technician | ~ |
Cathleen Smith | 50 First Avenue, Branford, CT 06405 | Radiographer | 2020-07-01 ~ 2021-06-30 |
Gita Thapa | 94 Village Lane, Branford, CT 06405 | Nail Technician | ~ |
Cycle Venture Partners Fund I Lp - Lumeda Series 1 | 50 Limewood Avenue, Branford, CT 06405 | Securities - Exemptions | 2020-06-17 ~ |
Find all Licenses in zip 06405 |
City | BRANFORD |
Zip Code | 06405 |
License Type | Physician Assistant |
License Type + County | Physician Assistant + BRANFORD |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Latha S Chirunomula | 3305 Kemper Road, Arlington, VA 22206 | Physician/surgeon | 2014-06-01 ~ 2015-05-31 |
Physician Assistant Foundation of The American Academy of Physician Assistants | 2318 Mill Rd Ste 1300, Alexandria, VA 22314-6868 | Public Charity | 2019-12-01 ~ 2020-11-30 |
Latha Voladri | 10 Huron Avenue, Jersey City, NJ 07306 | Dentist | 2005-09-15 ~ 2006-08-31 |
Latha Surapaneni | 28 Tall Oaks Dr, Monroe Township, NJ 08831-2417 | Pharmacist | ~ |
Swarna Latha Jaripita | 175 Carriage Club Dr, Mooresville, NC 28117 | Registered Nurse | 2019-06-01 ~ 2020-05-31 |
Latha Alaparthi Md | 2200 Whitney Ave Ste 360, Hamden, CT 06518 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Latha Dulipsingh Md | 100 Uplands Dr, West Hartford, CT 06107-1048 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Theresa V Horvath | Physiican Assistant Institute, Bridgeport, CT 06604 | Physician Assistant | 2018-10-01 ~ 2019-09-30 |
Quinnipiac University Physician Assistant Student Society | 370 Bassett Rd, North Haven, CT 06473-4201 | Raffle Permit Class 1 | 2017-01-12 ~ 2017-04-08 |
Connecticut Dermatology Physician Assistant Society Inc. | Po Box 847, Manchester, CT 06045 | Public Charity-exempt From Financial Requirements | ~ |
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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).