JASON R FEDAK PA (Credential# 743219) is licensed (Physician Assistant) 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.
JASON R FEDAK PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001470. The credential type is physician assistant. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 21 Heritage Dr, New Milford, CT 06776. The current status is active.
| Licensee Name | JASON R FEDAK PA |
| Credential ID | 743219 |
| Credential Number | 23.001470 |
| Credential Type | Physician Assistant |
| Business Address |
21 Heritage Dr New Milford CT 06776 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - PRIOR DISCIPLINE |
| Active | 1 |
| Issue Date | 2004-04-27 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-04-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 372785 | CSP.0035032 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-06-14 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 867348 | 70.950028 | Emergency Medical Technician | 1994-09-01 | - 1996-12-31 | INACTIVE |
| Street Address | 21 Heritage Dr |
| City | NEW MILFORD |
| State | CT |
| Zip Code | 06776 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Tai Nguyen | 3 Briar Ln, New Milford, CT 06776 | Nail Technician | 2020-06-27 ~ 2022-05-31 |
| Deborah Lee Winter | 22 Morey Road, New Milford, CT 06776 | Professional Counselor | 2020-06-01 ~ 2021-05-31 |
| Sega Ready Mix | 519 Danbury Rd, New Milford, CT 06776 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Nicole L Lynch | 13 Skyview Drive, New Milford, CT 06776 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Filipe Fialho Fernandes | 14 Wellsville Ave, New Milford, CT 06776 | Tattoo Technician | 2020-06-01 ~ 2022-05-31 |
| Petrela Nail & Spa Inc | 60 Park Lane Road, New Milford, CT 06776 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Carol S Glintenkamp | 12 Saddle Ridge Rd., New Milford, CT 06776 | Licensed Clinical Social Worker | 2020-07-01 ~ 2021-06-30 |
| Bradley A Kamp | 11 Saddle Ridge Road, New Milford, CT 06776 | Notary Public Appointment | 2020-10-01 ~ 2025-09-30 |
| John W Slattery | 8 West Meetinghouse Rd, New Milford, CT 06776 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Stephen J Ferreira | 123 Washington Ridge Road, New Milford, CT 06776 | Professional Engineer | 2020-06-26 ~ 2021-01-31 |
| Find all Licenses in zip 06776 | |||
| City | NEW MILFORD |
| Zip Code | 06776 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + NEW MILFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jason M Vogt Pa | 94 Pisgah Rd, Oxford, CT 06478 | Physician Assistant | 2014-08-01 ~ 2015-07-31 |
| Jason S Pinho | 52 Wolf Pit Rd, Farmington, CT 06032-2438 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Jason M Lorch | 22 Woodhill Rd, Trumbull, CT 06611-3356 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Jason D Milbert | 71 Starkweather St Fl 1, Manchester, CT 06042-3213 | Physician Assistant | 2018-05-01 ~ 2019-04-30 |
| Jason N Dacruz Pa | 31 Seymour Street, Hartford, CT 06106 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Jason David Williams | 145 Pomfret St, Putnam, CT 06260-1803 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Jason M Loftus | 760 Barry St, Feeding Hills, MA 01030-1010 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Jason P Kotula Pa | 286 Stonewell Dr, Saint Johns, FL 32259-8388 | Physician Assistant | 2018-08-01 ~ 2019-07-31 |
| Jason Nies | 464 Congress Avenue, New Haven, CT 06519 | Resident Physician Assistant | 2019-05-27 ~ 2020-12-31 |
| Jason Michael Nies | 815 State Street, New Haven, CT 06510-3346 | Physician Assistant | 2020-09-01 ~ 2021-08-31 |
Please comment or provide details below to improve the information on JASON R FEDAK PA.
| 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).