SHIVAM G PATEL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007987

License Status

NOT RENEWED

Business

First Name

SHIVAM

Middle

Last Name

PATEL

Business Name

SHIVAM G PATEL

Original Issue Date

10/02/2020

Effective Date

10/02/2020

Expiration Date

03/01/2022

City

SOUTH BOSTON

State

Zip

02127

Ever Disciplined

LastModifiedDate

07/27/2022