SUPRIYA SHAH SULLIVAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074249

License Status

ACTIVE

Business

Title

First Name

SUPRIYA

Middle

SHAH

Last Name

SULLIVAN

Business Name

SUPRIYA SHAH SULLIVAN MD

Original Issue Date

06/26/2025

Effective Date

06/26/2025

Expiration Date

07/17/2025

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

05/08/2025