SUPARNA T SHIVASHANKARA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064170

License Status

CANCELLED

Business

Title

First Name

SUPARNA

Middle

Last Name

SHIVASHANKARA

Business Name

SUPARNA T SHIVASHANKARA MD

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2017

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

03/28/2016