SUMARA IMTIAZ CHOUDHRY (Credential# 1458619) 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 ACTIVE.
SUMARA IMTIAZ CHOUDHRY is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004040. The credential type is physician assistant. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 2800 Main Street, Bridgeport, CT 06610-1662. The current status is active.
| Licensee Name | SUMARA IMTIAZ CHOUDHRY |
| Credential ID | 1458619 |
| Credential Number | 23.004040 |
| Credential Type | Physician Assistant |
| Business Address |
2800 Main Street Bridgeport CT 06610-1662 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-02-22 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-06-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1530376 | CSP.0069044 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-07-16 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 2800 MAIN STREET |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06610-1662 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Vivek Kesari | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Kalpana Shah | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Yassir J Ahmad | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Pankaj Nepal | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2018-07-01 ~ 2022-06-30 |
| Simon Castro | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2018-07-01 ~ 2021-08-24 |
| Dena Asaad Reiter | 2800 Main Street, Bridgeport, CT 06606 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Maureen Mansour | 2800 Main Street, Bridgeport, CT 06606 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Reba Varughese | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Sylvester Dorobisz | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Pius Osei-bagyina | 2800 Main Street, Bridgeport, CT 06606 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Afc Urgent Care | 161 Boston Ave, Bridgeport, CT 06610-1662 | Outpatient Clinic | 2019-08-12 ~ 2022-09-30 |
| Rent A Center #04135 | 161 Boston Ave Ste 4, Bridgeport, CT 06610-1662 | Sterilization Permit for Bedding & Upholstered Furniture | 2014-05-01 ~ 2015-04-30 |
| Steven M Heffer | 161 Boston Ave, Bridgeport, CT 06610-1662 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Do Hyeon Kim | 161 Boston Ave, Bridgeport, CT 06610-1662 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nilca Janice Cardenales | 66 Rose St, Bridgeport, CT 06610 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Kiara Lizbeth Corporan | 10 Sturtevant Pl, Bridgeport, CT 06610 | Eyelash Technician | ~ |
| Alisha Garcia | 65 Berkeley Place, Bridgeport, CT 06610 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Pauline Parkes | 96 Virginia Avenue, Bridgeport, CT 06610 | Licensed Clinical Social Worker | ~ |
| Denise Reyes | 1125 Huntington Turnpike, Bridgeport, CT 06610 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Avery M Rilley | 80 Granfield Avenue, Bridgeport, CT 06610 | Pharmacy Technician | 2020-06-25 ~ 2021-03-31 |
| Bozena K. Malyszko | Bridgeport Hospital, Bridgeport, CT 06610 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Amy Espinosa | 146 Court D, Bridgeport, CT 06610 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Wilhelmina Jackson · Thomas | 172 Court D, Bridgeport, CT 06610 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Emma Agyeiwaa Vaczek | P.o Box 5223, Bridgeport, CT 06610 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06610 | |||
| City | BRIDGEPORT |
| Zip Code | 06610 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + BRIDGEPORT |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Choudhry Petroleum Inc | 934 Broad St, Meriden, CT 06450-3471 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Imtiaz A Khokhar | 42-06 195th Street, Flushing, NY 11358 | Physician/surgeon | 1996-08-02 ~ 1997-09-30 |
| Imtiaz Mohamed | 715 Duncan Avenue, Pittsburgh, PA 15237 | Physician/surgeon | ~ 1999-09-30 |
| Imtiaz Ahmad | 52 Main St, Bedford Hills, NY 10507-1814 | Physician/surgeon | 2019-03-01 ~ 2020-02-29 |
| Mubdiul Imtiaz Ali | 300 Cedar St, Tac S425, New Haven, CT 06520 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Husein Imtiaz Poonawala | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | Physician/surgeon | 2019-10-01 ~ 2020-10-31 |
| Imtiaz A Mallick | 152 Freedom Road, Pleasant Valley, NY 12569 | Physician/surgeon | 1998-09-15 ~ 1999-11-30 |
| Patricia Sumara | 3 Oakridge Drive, Old Lyme, CT 06371 | Notary Public Appointment | 2013-02-01 ~ 2018-01-31 |
| Cassandra Carew Sumara | 20799 Sunnydale St, Farmington Hills, MI 48336-5254 | Registered Nurse | 2017-03-16 ~ 2017-07-31 |
| 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 |
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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).