SOTONTE EBENIBO (Credential# 1466863) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2018. The license expiration date date is April 30, 2019. The license status is INACTIVE.
SOTONTE EBENIBO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.057263. The credential type is physician/surgeon. The effective date is May 1, 2018. The expiration date is April 30, 2019. The business address is 130 Division Street, Derby, CT 06418. The current status is inactive.
| Licensee Name | SOTONTE EBENIBO |
| Credential ID | 1466863 |
| Credential Number | 1.057263 |
| Credential Type | Physician/Surgeon |
| Business Address |
130 Division Street Derby CT 06418 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2017-12-21 |
| Effective Date | 2018-05-01 |
| Expiration Date | 2019-04-30 |
| Refresh Date | 2019-08-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1231386 | CSP.0057624 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2014-06-30 | 2017-03-01 - 2019-02-28 | LAPSED |
| 1487765 | 1.057447-RES | Resident Physician | 2014-07-01 | 2014-07-01 - 2018-06-30 | INACTIVE |
| Street Address | 130 Division Street |
| City | Derby |
| State | CT |
| Zip Code | 06418 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sara E Altieri | 130 Division Street, Derby, CT 06418 | Advanced Practice Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| James E Schmidt | 130 Division Street, Derby, CT 06418 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Jahnavi Kalidindi | 130 Division Street, Derby, CT 06418 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Brian M Ullman | 130 Division Street, Derby, CT 06418 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Bassam Choudhry | 130 Division Street, Derby, CT 06418 | Controlled Substance Registration for Practitioner | 2015-03-12 ~ 2017-02-28 |
| Griffin Hospital Development Fund Inc. | 130 Division Street, Derby, CT 06418 | Public Charity-exempt From Financial Requirements | ~ |
| Pain Research and Education Foundation Inc | 130 Division Street, Derby, CT 06418 | Public Charity | ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Debra A Montini | 8 Academy Hill Ext, Derby, CT 06418 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Laura M Boanno | 131 Marshall La, Derby, CT 06418 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Danyun Chen | 49 Pershing Dr., Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Fan Geng | Shoprite Shopping Center, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Danni Xu | Shoprite Shopping Center49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Yao Zhang | Shoprite Shopping Center 49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Phillip N Burke | 3 Camptown St, Derby, CT 06418 | Emergency Medical Technician | 2017-06-07 ~ 2020-06-30 |
| Diane A Rosner | 229 Shagbark Drive, Derby, CT 06418 | Professional Counselor | 2020-08-01 ~ 2021-07-31 |
| Pamela C Lavelle | 194 Minerva St, Derby, CT 06418 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Grade A Market - Derby LLC | 49 Pershing Dr, Derby, CT 06418 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06418 | |||
| City | Derby |
| Zip Code | 06418 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Derby |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
| John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Barbara M Galko Md | Danbury Office of Physician Services PC, Danbury, CT 06810 | Physician/surgeon | 2010-06-01 ~ 2011-05-31 |
| Barbara A Brandes Md | Danbury Office of Physician Services, Danbury, CT 06810 | Physician/surgeon | 2004-07-08 ~ 2005-07-31 |
Please comment or provide details below to improve the information on SOTONTE EBENIBO.
| 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).