SURESH MANDAVA (Credential# 554523) is licensed (Physician/surgeon) 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.
SURESH MANDAVA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.036932. The credential type is physician/surgeon. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 2046 W. Main St. Ste 2, Stamford, CT 06902. The current status is active.
| Licensee Name | SURESH MANDAVA |
| Credential ID | 554523 |
| Credential Number | 1.036932 |
| Credential Type | Physician/Surgeon |
| Business Address |
2046 W. Main St. Ste 2 Stamford CT 06902 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1998-06-05 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-06-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 160598 | CSP.0027236 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-15 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 2046 W. Main St. Ste 2 |
| City | STAMFORD |
| State | CT |
| Zip Code | 06902 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Joseph Conway Jr | 2046 W. Main St. Ste 2, Stamford, CT 06902 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Donna L Densel | 2046 W. Main St. Ste 2, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jerry W Tsong | 2046 W. Main St. Ste 2, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jeris Maydeli Flores | 153 Fairfield Av, Stamford, CT 06902 | Nail Technician | ~ |
| Reynaldo De La Cruz | 64 Brookside Drive, Stamford, CT 06902 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Darren J Petillo | 5 Hundley Court, Stamford, CT 06902 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| Antonios Restaurant | 405 West Main St, Stamford, CT 06902 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Edward Smith | 184 Fairfield Ave., Stamford, CT 06902 | Home Improvement Contractor | ~ |
| Margaret A Dorrance | 24c Hamilton Court, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Carolyn Maguire | 48 Nelson St, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Evelyne Joassin | 17 George St., Stamford, CT 06902 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Andrea Bynoe | 34 Melrose Pl, Stamford, CT 06902 | Notary Public Appointment | 1994-04-06 ~ 1999-04-30 |
| Ravi K Ahuja | 296 Westover Rd, Stamford, CT 06902 | Architect | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06902 | |||
| City | STAMFORD |
| Zip Code | 06902 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + STAMFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Anisha Mandava | University of Connecticut, Farmington, CT 06030 | Physician/surgeon | 2009-06-01 ~ 2010-06-30 |
| Suresh Khanna | 11 Oxridge Rd, Elmsford, NY 10523 | Physician/surgeon | 2009-08-01 ~ 2010-07-31 |
| Suresh K Gulati | 45 Calumet Rd, Winchester, MA 01890 | Physician/surgeon | 2012-10-01 ~ 2013-09-30 |
| Vinod Suresh | 551 Observer Hwy Apt 11d, Hoboken, NJ 07030-6563 | Physician/surgeon | 2020-06-22 ~ 2021-05-31 |
| Suresh J Tanna | 5001 Statesman Dr, Irving, TX 75063-2414 | Physician/surgeon | ~ |
| Padma Suresh | 10 Linmoor Terrace, Lexington, MA 02420 | Physician/surgeon | 2009-06-01 ~ 2010-06-30 |
| Deepa Suresh | 5907 Lake St, Houston, TX 77005-3129 | Physician/surgeon | 2009-07-24 ~ 2010-05-31 |
| Suresh Mamidala | 1133 Midland Ave, Bronxville, NY 10708 | Physician/surgeon | 2012-05-01 ~ 2013-04-30 |
| Suresh S Shah Md | 7128 Ridgewood Dr, Lockport, NY 14094 | Physician/surgeon | 2006-01-10 ~ 2007-02-28 |
| Suresh Koneru | 1722 Asoen Ridge, San Antonio, TX 78248 | Physician/surgeon | 1996-01-26 ~ 1997-03-31 |
Please comment or provide details below to improve the information on SURESH MANDAVA.
| 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).