License holder summary

Shannon C Blake is a Physician Assistants - Physician Assistant licensed to practice in Massachusetts. The address on file for Shannon C Blake is United States, West Hartford 06110. This licensed professional license is current. The license was granted 07/06/2004 and expired on 03/01/2017.

Massachusetts

Division of Professional Licensure

Shannon C Blake
Physician Assistants - Physician Assistant
License number
PA1804
Date granted
07/06/2004
Date expires
03/01/2017
Class
Physician Assistants - Physician Assistant
Status
Current
Address
United States
licensingma.org
ID 38592762
LAST UPDATED 2026-04-02 19:45:16 UTC

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