SAILAJA MALLA (Credential# 565078) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is February 1, 2010. The license expiration date date is January 31, 2011. The license status is INACTIVE.
SAILAJA MALLA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.047496. The credential type is physician/surgeon. The effective date is February 1, 2010. The expiration date is January 31, 2011. The business address is 123 N Lakewood Dr, Ridgeley, WV 26753-9723. The current status is inactive.
| Licensee Name | SAILAJA MALLA |
| Credential ID | 565078 |
| Credential Number | 1.047496 |
| Credential Type | Physician/Surgeon |
| Business Address |
123 N Lakewood Dr Ridgeley WV 26753-9723 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2009-03-25 |
| Effective Date | 2010-02-01 |
| Expiration Date | 2011-01-31 |
| Refresh Date | 2011-05-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 450670 | CSP.0040648 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2006-12-14 | 2008-03-04 - 2009-02-28 | INACTIVE |
| Street Address | 123 N LAKEWOOD DR |
| City | RIDGELEY |
| State | WV |
| Zip Code | 26753-9723 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Stacey L Dennison | Rt 2 Box 284, Ridgeley, WV 26753 | Registered Nurse | ~ |
| Jared Duncan | 699 Sherwood Dr., Ridgeley, WV 26753 | Physical Therapist Assistant | 2016-03-01 ~ 2017-02-28 |
| City | RIDGELEY |
| Zip Code | 26753 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + RIDGELEY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sailaja Kalidasu | 76 Heseman Avenue, Brooklyn, NY 11212 | Physician/surgeon | ~ |
| Sailaja Gulipelli | 89 Fleet Pl, Mineola, NY 11501 | Physician/surgeon | 2007-06-15 ~ 2008-06-30 |
| Sailaja Puttagunta Md | 39 Buell Hill Rd, Killingworth, CT 06419 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Maria Malla | 70 Pond Meadow Rd, Ivoryton, CT 06442 | Nail Technician | 2020-06-18 ~ 2021-10-31 |
| Marissa B Malla Iniguez | 22 Holley St, Danbury, CT 06810-6132 | Pharmacy Technician | 2020-02-04 ~ 2021-03-31 |
| Malla Imhoff | 120 Holcomb Street, Hartford, CT 06112-1589 | Medication Administration Certification | 1994-06-14 ~ 1996-06-13 |
| Sailaja Ganga | 41 Franklin St, Woonsocket, RI 02895 | Pharmacist | 2014-02-01 ~ 2016-01-31 |
| Sailaja B Bhaskar | 1900 Summer Street, Stamford, CT 06905 | Pharmacist | ~ |
| Sailaja Pindiprolu Md | 8503 Cory Drive, Bowie, MD 20720 | Controlled Substance Registration for Practitioner | 2001-03-01 ~ 2002-02-28 |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
Please comment or provide details below to improve the information on SAILAJA MALLA.
| 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).