LATHA ANEKONDADHA REVAKALA
Physician Assistant


Address: 20 Montoya Dr Unit 21, Branford, CT 06405-2534

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.

Business Overview

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.

Basic Information

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

Other licenses

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

Office Location

Street Address 20 MONTOYA DR UNIT 21
City BRANFORD
State CT
Zip Code 06405-2534

Licenses in the same zip code

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

Licenses in the same zip code

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 ~
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Competitor

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City BRANFORD
Zip Code 06405
License Type Physician Assistant
License Type + County Physician Assistant + BRANFORD

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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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