AMJAD PANICKAVEETTIL MOHAMED BASHEER (Credential# 1675644) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is July 15, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
AMJAD PANICKAVEETTIL MOHAMED BASHEER is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0071925. The credential type is controlled substance registration for practitioner. The effective date is July 15, 2019. The expiration date is February 28, 2021. The business address is 263 Farmington Ave, Farmington, CT 06030-0001. The current status is active.
| Licensee Name | AMJAD PANICKAVEETTIL MOHAMED BASHEER |
| Credential ID | 1675644 |
| Credential Number | CSP.0071925 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
263 Farmington Ave Farmington CT 06030-0001 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-07-15 |
| Effective Date | 2019-07-15 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-07-16 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Amjad Panickaveettil Mohamed Basheer | 263 Farmington Avenue, Farmington, CT 06030-1921 | Resident Physician | 2019-06-28 ~ 2022-06-30 |
| Street Address | 263 FARMINGTON AVE |
| City | FARMINGTON |
| State | CT |
| Zip Code | 06030-0001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Erica Shen Nofziger | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2027-06-30 |
| Matthew D Goranson | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2026-06-30 |
| Jacob Silver | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Nicholas Bellas | 263 Farmington Ave, Farmington, CT 06032-1956 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Jennifer Hale | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Cory R Hewitt | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Sango Huwaa Mosia Asante | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Ryan Desrochers | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Kelsey D Greenhalgh | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Dentist | 2019-07-01 ~ 2025-06-30 |
| Derek J Tow | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Dentist | 2019-07-01 ~ 2025-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Wendy A Miller | Mc1921 Farmington Ave # 263, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jason J Ziegler | 2 Courthouse Square, Farmington, CT 06030-0001 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Bryden T Considine | L2104 of Medicine Rm, Farmington, CT 06030-0001 | Resident Physician | 2017-07-03 ~ 2021-06-30 |
| Dillon Paulo | 4260 Cordoba Ct, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Omar Ibrahim | 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jillian L Fortier | Uconn Health Center, Department of Surgery, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Douglas Zelisko | 263 Farmington Ave Dept Of, Farmington, CT 06030-0001 | Physician/surgeon | 2020-04-23 ~ 2021-01-31 |
| Ruchir D Trivedi | 263 Farmington Ave # Mc-1405, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Rawan J.j. Sarsour | 263 Farmington Ave # Mc3905, Farmington, CT 06030-0001 | Provisional Faculty Dentist | 2020-04-21 ~ 2021-04-30 |
| Angela Hart | General Medicine- Outpatient Pavilion, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Find all Licenses in zip 06030-0001 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eric Anthony Brueckner | 263 Farmington Ave., Farmington, CT 06030 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Derrick B Bremang | Residency Program, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| David M Shafer | Uconn Health Center, Farmington, CT 06030 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Michael J Murphy | Dept of Dermatology, Farmington, CT 06030 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Richard F Kaplan | Univ. of Ct., Farmington, CT 06030 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Nicholas George Vitale | 22 Woods Drive, Norwich, CT 06030 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Bruce E Gould | Univ of Conn Health Center, Farmington, CT 06030 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Vinayak M Sathe | Uconn Health Center,263 Farmington Ave, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shobhana Pathani | Department of Medicine, 263 Farmington Ave, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Patricia L Almeida | John Dempsey Hospital, Farmington, CT 06030 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in zip 06030 | |||
| City | FARMINGTON |
| Zip Code | 06030 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + FARMINGTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Amjad Minhas | 56 Franklin St, Waterbury, CT 06706-1253 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Halima Amjad | 900 Chapel St, New Haven, CT 006510 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Muhammad Saad Bin Amjad | 23 Florence Way, Farmington, CT 06032 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Ambreen Mohamed | 90 5th Ave Apt 4, Brooklyn, NY 11217-4613 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Mohamed El-dib | 282 Washington St, Hartford, CT 06106-3322 | Controlled Substance Registration for Practitioner | 2011-11-10 ~ 2013-02-28 |
| Mohamed A Antar Md | 152 Lebanon Rd, Bethany, CT 06524-3009 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mohamed Zakarya | 1 Hospital Plz, Stamford, CT 06902-3602 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mohamed S Ahmed | Po Box 9317, Stamford, CT 06904 | Controlled Substance Registration for Practitioner | 2004-08-20 ~ 2005-02-28 |
| Khaled I Mohamed Md | 72 Greenridge Ave, White Plains, NY 10605-1618 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mohamed M Elsamra Md | 19 Ellis Rd, East Haven, CT 06512 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
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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).