VARSHA SHAH MD
BROOKSIDE PEDIATRICS


Address: 1185 Melville Ave, Fairfield, CT 06825-2017

VARSHA SHAH MD (Credential# 542788) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.

Business Overview

VARSHA SHAH MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.018579. The credential type is physician/surgeon. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 1185 Melville Ave, Fairfield, CT 06825-2017. The current status is active.

Basic Information

Licensee Name VARSHA SHAH MD
Business Name BROOKSIDE PEDIATRICS
Credential ID 542788
Credential Number 1.018579
Credential Type Physician/Surgeon
Business Address 1185 Melville Ave
Fairfield
CT 06825-2017
Business Type INDIVIDUAL
Status ACTIVE - CURRENT
Active 1
Issue Date 1977-01-12
Effective Date 2020-05-01
Expiration Date 2021-04-30
Refresh Date 2020-02-27

Other licenses

ID Credential Code Credential Type Issue Term Status
1331490 CSP.0062044 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2016-02-03 2017-03-01 - 2019-02-28 LAPSED
149460 CSP.0001271 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2006-03-01 2013-03-01 - 2015-02-28 INACTIVE

Office Location

Street Address 1185 MELVILLE AVE
City FAIRFIELD
State CT
Zip Code 06825-2017

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Benjamin Allan Gott 262 Euclid Avenue, Fairfield, CT 06825 Notary Public Appointment 2020-06-01 ~ 2025-05-31
Charles J Applebaum 841 Stratfield Rd, Fairfield, CT 06825 Dentist 2020-07-01 ~ 2021-06-30
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Competitor

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City FAIRFIELD
Zip Code 06825
License Type Physician/Surgeon
License Type + County Physician/Surgeon + FAIRFIELD

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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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