SALLY Y SA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003371

License Status

NOT RENEWED

Business

First Name

SALLY

Middle

Last Name

Business Name

SALLY Y SA

Original Issue Date

10/23/2008

Effective Date

03/01/2010

Expiration Date

03/01/2012

City

NEW YORK

State

Zip

10065

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012