SHEELA DEIVANAYAGAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

First Name

SHEELA

Last Name

DEIVANAYAGAM

Suffix

Business Name

SHEELA DEIVANAYAGAM MD

Original Issue Date

05/14/2007

Effective Date

06/02/2008

Expiration Date

07/31/2011

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011