| Entity Name: | SHAHEDA QAIYUMI, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 19 Mar 1986 (39 years ago) |
| Date of dissolution: | 18 Jan 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 18 Jan 2018 (7 years ago) |
| Document Number: | J04762 |
| FEI/EIN Number | 59-2638693 |
| Address: | 7109 N.W. 11TH PLACE, SUITE A, GAINESVILLE, FL 32605 |
| Mail Address: | 7109 N.W. 11TH PLACE, SUITE A, GAINESVILLE, FL 32605 |
| ZIP code: | 32605 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730101643 | 2006-07-23 | 2008-02-28 | 7109 NW 11TH PL STE A, GAINESVILLE, FL, 326053141, US | 7109 NW 11TH PL STE A, GAINESVILLE, FL, 326053141, US | |||||||||||||||||||||||||
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| Phone | +1 352-331-2890 |
| Fax | 3523312915 |
Authorized person
| Name | DR. SHAHEDA QAIYUMI |
| Role | PRESIDENT |
| Phone | 3523312890 |
Taxonomy
| Taxonomy Code | 207RR0500X - Rheumatology Physician |
| License Number | ME 0042491 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 94896 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| QAIYUMI, SHAHEDA | Agent | 7109 N.W. 11 PLACE, SUITE A, GAINESVILLE, FL 32605 |
| Name | Role | Address |
|---|---|---|
| QAIYUMI, SHAHEDA | DR. | 7109 N.W. 11TH PLACE, SUITE A GAINESVILLE, FL 32605 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-01-18 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-01-14 | 7109 N.W. 11TH PLACE, SUITE A, GAINESVILLE, FL 32605 | No data |
| CHANGE OF MAILING ADDRESS | 2009-01-14 | 7109 N.W. 11TH PLACE, SUITE A, GAINESVILLE, FL 32605 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-01-14 | 7109 N.W. 11 PLACE, SUITE A, GAINESVILLE, FL 32605 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-01-09 |
| ANNUAL REPORT | 2015-01-16 |
| ANNUAL REPORT | 2014-01-30 |
| ANNUAL REPORT | 2013-01-25 |
| ANNUAL REPORT | 2012-01-13 |
| ANNUAL REPORT | 2011-02-01 |
| ANNUAL REPORT | 2010-01-12 |
| ANNUAL REPORT | 2009-01-14 |
| ANNUAL REPORT | 2008-01-04 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
