SHELLY STONE SHALLAT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

ACTIVE

Business

First Name

SHELLY

Middle

STONE

Last Name

SHALLAT

Suffix

Business Name

SHELLY STONE SHALLAT MD

Original Issue Date

08/17/1999

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

METAMORA

State

Zip

61548

County

WOODFORD

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

06/22/2023