KOMSU F MAMUYA MD (Credential# 565504) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
KOMSU F MAMUYA MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.047922. The credential type is physician/surgeon. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 1260 Silas Deane Hwy Ste 106, Wethersfield, CT 06109-4363. The current status is active.
| Licensee Name | KOMSU F MAMUYA MD |
| Credential ID | 565504 |
| Credential Number | 1.047922 |
| Credential Type | Physician/Surgeon |
| Business Address |
1260 Silas Deane Hwy Ste 106 Wethersfield CT 06109-4363 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2009-07-02 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-12-05 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 533923 | CSP.0045574 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2009-07-20 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 1260 SILAS DEANE HWY STE 106 |
| City | WETHERSFIELD |
| State | CT |
| Zip Code | 06109-4363 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kenneth A Merkatz Md | 1260 Silas Deane Hwy Ste 106, Wethersfield, CT 06109-4363 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Christeen Mcardle Pa | 1260 Silas Deane Hwy Ste 106, Wethersfield, CT 06109-4363 | Physician Assistant | 2012-01-01 ~ 2012-12-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Christine T Mccrary | 1260 Silas Deane Hwy Ste 105b, Wethersfield, CT 06109-4363 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Scott J Walker Md | 1260 Silas Deane Hwy Ste 105, Wethersfield, CT 06109-4363 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Stephen I Firshein Md | 1260 Silas Deane Hwy Ste 107, Wethersfield, CT 06109-4363 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Thomas Savinelli Md | 1260 Silas Deane Hwy Ste 109a, Wethersfield, CT 06109-4363 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jennifer R Decker Dpm | 1260 Silas Deane Hwy Ste 105, Wethersfield, CT 06109-4363 | Controlled Substance Registration for Practitioner | 2015-02-05 ~ 2017-02-28 |
| Brian D Timms Do | 1260 Silas Deane Hwy Ste 105, Wethersfield, CT 06109-4363 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Susan E Dimauro | 330 Ridge Rd, Wethersfield, CT 06109 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Mary Boccacio | 174 Longvue Drive, Wethersfield, CT 06109 | Esthetician | ~ |
| Steven C Hine | 294 Hang Dog Ln, Wethersfield, CT 06109 | Architect | 2020-08-01 ~ 2021-07-31 |
| Karolina Monika Fitrzyk | 41 Mountain Laurel, Wethersfield, CT 06109 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Matthew R Dobos | 33 Oxford St, Wethersfield, CT 06109 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Samantha Grabbe | 17 Rockland St, Wethersfield, CT 06109 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Judith M Martz | 307 Nott Street, Wethersfield, CT 06109 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Ups Store (the) | 1077 Silas Deane Hwy, Wethersfield, CT 06109 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Amber H Washington | 103 Parkview Drive, Wethersfield, CT 06109 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Kathleen A Mullady · Brancati | 75 Dale Rd, Wethersfield, CT 06109 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06109 | |||
| City | WETHERSFIELD |
| Zip Code | 06109 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + WETHERSFIELD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Barbara A Brandes Md | Danbury Office of Physician Services, Danbury, CT 06810 | Physician/surgeon | 2004-07-08 ~ 2005-07-31 |
| Sajot S Grewal Md | Danbury Office of Physician Services PC, Danbury, CT 06810 | Physician/surgeon | 2004-01-30 ~ 2005-03-31 |
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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).