SHANA J SEWELL DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036112396

License Status

NOT RENEWED

Business

First Name

SHANA

Middle

Last Name

SEWELL

Suffix

Business Name

SHANA J SEWELL DO

Original Issue Date

09/21/2004

Effective Date

05/16/2017

Expiration Date

09/30/2020

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

01/14/2021