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Licensing details for: PTL 5510

Name: SHIFFLETT, KENDALL ANNE

License Type: Postgraduate Training License

Primary Status: License Canceled Primary Status Definition

School Name: Geisinger Commonwealth School of Medicine

Graduation Year: 2020

Previous Names: Shifflett, Kendall Anne

Current Enrolled Postgraduate Training Program

Facility Name: Olive View/UCLA Medical Center Program

City: Sylmar

State: California

Speciality: Internal Medicine

Start Date: 06/24/2020

Anticipated End Date: 01/21/2022

Address of Record

350 E Del Mar Blvd Apt 112
PASADENA CA 91101-2749
LOS ANGELES county
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Issuance Date

February 15, 2021

Expiration Date

N/A

Current Date / Time

April 3, 2026
10:13:17 AM

Public Record Actions

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Postgraduate Training License

Related Party Role: Physician & Surgeon

Name: SHIFFLETT, KENDALL ANNE

License/Registration Type: Physician's and Surgeon's

License Number: 192405 Primary Status: Delinquent - License renewal fee has not been paid. No practice is permitted.

Address :
2480 Sonoma St
REDDING CA 96001-3027
SHASTA COUNTY

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