License Verification

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SHANNIA FULLERTON

License Number: AA621

Data As Of 9/28/2024

Profession
Anesthesiologist Assistant
License
AA621
License Status
CLEAR/Active
License Expiration Date
1/31/2025
License Original Issue Date
09/23/2020
Address of Record
2627 West Eau Gailie Blvd
Suite 101
MELBOURNE, FL 32935
Discipline on File
No
Public Complaint
No
Address
62 Columbia Street OH Jewet tOrtho Insti
ORLANDO, FL 32806
Name Relationship Profession License Effective Date
ABDUL, FIRAS SALEH SUPERVISOR for AA Medical Doctor 109007 01/03/2023
BUTLER, NATALIE VINCENT SUPERVISOR for AA Medical Doctor 112397 10/25/2020
FIER, ADAM RYAN DO SUPERVISOR for AA Osteopathic Physician 10956 10/25/2020
FONG, TYLER SUPERVISOR for AA Medical Doctor 151110 07/24/2023
FORD, MARIKO SUPERVISOR for AA Medical Doctor 145119 07/24/2023
KAUFMANN, MARC WALTER SUPERVISOR for AA Osteopathic Physician 14373 10/25/2020
MAYBURY, EDWARD ALLEN JR SUPERVISOR for AA Medical Doctor 79595 10/25/2020
MCKILLEN, JULIA BASKIN SUPERVISOR for AA Medical Doctor 154797 07/01/2023
NOVA, HUGO A SUPERVISOR for AA Medical Doctor 111882 10/25/2020
NOVO, ROBERT FRANK SUPERVISOR for AA Osteopathic Physician 11280 10/25/2020
PRESTON, WILLIAM LAURENCE MD SUPERVISOR for AA Medical Doctor 68478 10/25/2020
ROGERS, JONATHAN MATTHEW SUPERVISOR for AA Medical Doctor 99871 10/25/2020
SCHRADER, KEITH JOSEPH MD SUPERVISOR for AA Medical Doctor 48296 10/25/2020
SHAH, NIPA ROHITKUMAR SUPERVISOR for AA Medical Doctor 108963 04/05/2023
SHORE, JEFFREY MICHAEL SUPERVISOR for AA Medical Doctor 96836 10/25/2020
VANALLEN, KARY LAMARR SUPERVISOR for AA Medical Doctor 77302 03/20/2023
VARADY, ADAM ERNO SUPERVISOR for AA Medical Doctor 123215 10/25/2020
VOSE, STEPHEN OLIVER SUPERVISOR for AA Medical Doctor 119601 05/22/2023
WALKER, SHERYL MD SUPERVISOR for AA Medical Doctor 92373 04/03/2023

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 9/28/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.