SHANE PETERSON (Credential# 2053125) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2020. The license expiration date date is June 30, 2024. The license status is ACTIVE.
SHANE PETERSON is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.066143-RES. The credential type is resident physician. The effective date is July 1, 2020. The expiration date is June 30, 2024. The business address is 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037. The current status is active.
| Licensee Name | SHANE PETERSON |
| Credential ID | 2053125 |
| Credential Number | 1.066143-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
80 Seymour St, Po Box 5037 Hartford CT 06102-5037 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2020-07-01 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2024-06-30 |
| Refresh Date | 2020-06-08 |
| Street Address | 80 Seymour St, PO Box 5037 |
| City | Hartford |
| State | CT |
| Zip Code | 06102-5037 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lilly Rizzo | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Emily Rosen-wachs | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Carolina Vicens Cardona | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Iiham Putra | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Ronald Weir | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Gabriela Cepeda De Jesus | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Asmita Patel | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Amjad Saad | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Isabel Guillen-mendez | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Kelvin Diaz | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Danielle Brainard | 80 Seymour St Po Box 5037, Hartford, CT 06102-5037 | Resident Dentist | 2020-07-01 ~ 2021-06-30 |
| Andrew Ding | Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| David I Silverman Md | Hartford Hospital, Hartford, CT 06102-5037 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Erica A Schuyler Md | Hartford Hospital/neurology, Hartford, CT 06102-5037 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Heather R Leonard | Hartford Hospital Emergency Department, Hartford, CT 06102-5037 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Timothy S Boyd Md | Hartford Hospital/gray Cancer Ctr, Hartford, CT 06102-5037 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Hartford Hospital | Dept of Food and Nutrition Services, Hartford, CT 06102-5037 | Vending Machine Operator | 2012-07-01 ~ 2013-06-30 |
| Orlando C Kirton Md | Hartford Hospital-dept of Surgery, Hartford, CT 06102-5037 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Charles Ingardia Md | Hartford Hospital/prenatal Testing, Hartford, CT 06102-5037 | Physician/surgeon | 2014-04-01 ~ 2015-03-31 |
| James J Glazier | Cardial Lab, Hartford, CT 06102-5037 | Physician/surgeon | 1995-07-05 ~ 1996-05-31 |
| Find all Licenses in zip 06102-5037 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sivabalaji Kaliamurthy | 80 Seymour Street, Hartford, CT 06102 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Erica S Hammer | 85 Jefferson Ave Ste 625, Hartford, CT 06102 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Joseph A Digiuseppe | Dept of Pathology, Hartford, CT 06102 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Joseph V Portereiko Do | Hartford Hospital : Department of Surgery, Hartford, CT 06102 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Vasanthy Thevarajah | Hardfort Hospital, Hartford, CT 06102 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Elaine Manson | 135 Dapex, Hartford, CT 06102 | Medication Administration Certification | ~ |
| Valridine Durrant | 2718 Main St, Hartford, CT 06102 | Medication Administration Certification | 2020-03-08 ~ 2022-03-07 |
| Jennifer Susan Thran | 80 Seymore St, Hartford, CT 06102 | Registered Nurse | ~ |
| Monique M Vaughan | 401 Granby Street, Hartford, CT 06102 | Real Estate Salesperson | ~ |
| Bruce M Kaplan Md | Hartford Hospital Gray Cancer Center, Hartford, CT 06102 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Find all Licenses in zip 06102 | |||
| City | Hartford |
| Zip Code | 06102 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + Hartford |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Danielle M Peterson | 22 Gold St Apt 116, New Haven, CT 06519-1602 | Resident Physician | 2019-08-01 ~ 2021-08-01 |
| Ryan Thomas Peterson | 720 Harrison Ave, Dob 9th Floor, Rm 915, Boston, MA 02118 | Resident Physician | 2016-07-01 ~ 2021-06-30 |
| Shane D Peterson | 55 Mill Plain Rd Unit 19-1, Danbury, CT 06811-5159 | Emergency Medical Technician | 2020-03-12 ~ 2021-12-31 |
| Peterson & Peterson Cpa's | 143 Rowayton Avenue, Rowayton, CT 06853 | Certified Public Accountant Firm Permit | 1996-01-01 ~ 1996-12-31 |
| Mr Shane's Ice Cream · Mr Shane's Homemade Parlour Ice Cream Inc | 409 Main St, Ridgefield, CT 06877 | Frozen Dessert Wholesaler | 2003-08-15 ~ 2003-12-31 |
| Peterson Oil Co | 276 Main St, Portland, CT 06480 | Motor Fuel Quality Registration | 2006-11-01 ~ 2007-10-31 |
| Walter B Peterson II · Peterson Enterprises | 7 Brushy Hill Road, Danbury, CT 06810 | Home Improvement Contractor | 2019-12-01 ~ 2020-11-30 |
| Elizabeth W Peterson · Peterson Engineering | 15 Browns Crossing, Gales Ferry, CT 06335 | Home Improvement Contractor | 1997-12-01 ~ 1998-11-30 |
| Shane Johnson · Shane's Replace & Remodel | 246 W Hill Rd, Torrington, CT 06790-4529 | Home Improvement Contractor | 2017-12-01 ~ 2018-11-30 |
| Charles M Peterson · Peterson Siding | 11 Schwab Terrace, Wallingford, CT 06492 | Home Improvement Contractor | 1998-12-01 ~ 1999-11-30 |
Please comment or provide details below to improve the information on SHANE PETERSON.
| 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).