SHANNON C BLAKE PA (Credential# 743299) is licensed (Physician Assistant) 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.
SHANNON C BLAKE PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001550. The credential type is physician assistant. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 1217 Tidalwalk Dr, Wilmington, NC 28409. The current status is active.
| Licensee Name | SHANNON C BLAKE PA |
| Credential ID | 743299 |
| Credential Number | 23.001550 |
| Credential Type | Physician Assistant |
| Business Address |
1217 Tidalwalk Dr Wilmington NC 28409 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2004-10-25 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-01-30 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 483923 | CSP.0042665 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2007-09-27 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 141213 | PTN.0001366 | PHARMACY TECHNICIAN | 1998-10-01 - 2000-03-31 | INACTIVE |
| Street Address | 1217 Tidalwalk dr |
| City | WILMINGTON |
| State | NC |
| Zip Code | 28409 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Cynthia S Godwin | 7223 Masonboro Sound Road, Wilmington, NC 28409 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Barbara M Cleary | 5613 Leisure Circle, Wilmington, NC 28409 | Real Estate Broker | 2020-04-01 ~ 2021-03-31 |
| Kelsey L Vallee | 1004 Annadale Ln, Wilmington, NC 28409 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Daniel W Zebroski | 6400 Ehler Court, Wilmington, NC 28409 | Professional Engineer | 2019-02-01 ~ 2020-01-31 |
| Lucille E Tomas | 118 Cabbage Inlet Lane, Wilmington, NC 28409 | Registered Nurse | 2018-05-01 ~ 2019-04-30 |
| Marissa M Zeller | 7616 Navigator Lane, Wilmington, NC 28409 | Registered Nurse | 2019-09-01 ~ 2020-08-31 |
| Angel A Pia | 3941 Willowick Park Drive, Wilmington, NC 28409 | Certified Public Accountant License | 2018-01-01 ~ 2018-12-31 |
| Marjorie H Clinton · Dollar Dry Dock Real Estate | 237 Chimney Ln, Wilmington, NC 28409 | Real Estate Salesperson | 1997-06-01 ~ 1998-05-31 |
| Victor F Rizzuto | 6262 Ingleside Dr, Wilmington, NC 28409 | Professional Engineer | 2003-02-01 ~ 2004-01-31 |
| Maureen M Robison | 6218 Head Rd, Wilmington, NC 28409 | Real Estate Broker | 1999-06-23 ~ 2000-05-31 |
| Find all Licenses in zip 28409 | |||
| City | WILMINGTON |
| Zip Code | 28409 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + WILMINGTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Shannon C Berger | 9 Colony Dr, Winsted, CT 06098 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Shannon Brigham | 41 Stanie Brae Dr, Watchung, NJ 07069-6231 | Physician Assistant | ~ |
| Shannon Gorton | 2800 Main St, Bridgeport, CT 06606-4201 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Shannon Carroll | 184 Summer St Apt 1610, Stamford, CT 06901-2352 | Physician Assistant | 2020-08-01 ~ 2021-07-31 |
| Shannon Lambert | 96 Corey Colonial, Agawam, MA 01001-2749 | Physician Assistant | 2011-12-01 ~ 2012-11-30 |
| Shannon Maxon Pa | 33 Cosey Beach Ave, East Haven, CT 06512-4905 | Physician Assistant | 2020-08-01 ~ 2021-07-31 |
| Erin Kate Shannon | 3240 Monroe Ave, Rochester, NY 14618 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Shannon Marie Keohane | 2655 Northwinds Pkwy, Alpharetta, GA 30009-2280 | Physician Assistant | 2020-09-01 ~ 2021-08-31 |
| Lbf Blake St Convenience LLC · Blake St Convenience | 295 Blake St, New Haven, CT 06515-1295 | Dealer of Electronic Nicotine Delivery System Or Vapor Product | 2020-05-15 ~ 2021-02-28 |
| Ronald W Blake · Ron Blake Carpentry | 49 Thomaston Rd, Morris, CT 06763 | Home Improvement Contractor | 1997-07-08 ~ 1997-11-30 |
Please comment or provide details below to improve the information on SHANNON C BLAKE 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).