SALLY M MANDICHAK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

VISITING RESIDENT

License Number

188000922

License Status

EXPIRED

Business

First Name

SALLY

Middle

Last Name

MANDICHAK

Business Name

SALLY M MANDICHAK

Original Issue Date

01/08/2021

Effective Date

01/08/2021

Expiration Date

07/08/2021

City

PORTSMOUTH

State

Zip

23704

County

VIRGINIA

Specialty/Qualifier

Trauma Rotation

Ever Disciplined

LastModifiedDate

10/11/2022