SAMATA J SHROFF Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****12

License Status

ACTIVE

Business

First Name

SAMATA

Middle

Last Name

SHROFF

Business Name

SAMATA J SHROFF

Original Issue Date

10/17/2005

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

PARK CITY

State

Zip

60085

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025