| Entity Name: | CHILD NEUROLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 21 Mar 2006 (19 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L06000029693 |
| FEI/EIN Number | 13-4331551 |
| Address: | 4440 SHERIDAN STREET, HOLLYWOOD, FL 33021 |
| Mail Address: | 4440 SHERIDAN STREET, HOLLYWOOD, FL 33021 |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710924956 | 2006-05-31 | 2008-05-16 | 4440 SHERIDAN STREET, HOLLYWOOD, FL, 33021, US | 4440 SHERIDAN STREET, HOLLYWOOD, FL, 33021, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-961-2423 |
| Fax | 9549614860 |
Authorized person
| Name | DR. TATYANA DUBROVSKY |
| Role | MANAGER OF THE CHILD NEUROLOGY LLC |
| Phone | 9549612423 |
Taxonomy
| Taxonomy Code | 2084N0402X - Neurology with Special Qualifications in Child Neurology Physician |
| License Number | ME70907 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 77841 |
| State | FL |
| Issuer | PEDIATRIC ASSOCIATES PSN |
| Number | 276469500 |
| State | FL |
| Issuer | FL NETPASS |
| Number | 276469500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 276469500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ATKINSON, WILSON CIII,ESQ | Agent | C/O ATKINSON, DINER, ET AL, ONE FINANCIAL PLAZA, SUITE 1400, FT. LAUDERDALE, FL 33394 |
| Name | Role | Address |
|---|---|---|
| DUBROVSKY, TATYANA | Managing Member | 4440 SHERIDAN STREET, HOLLYWOOD, FL 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-01-09 |
| ANNUAL REPORT | 2009-02-15 |
| ANNUAL REPORT | 2008-01-12 |
| ANNUAL REPORT | 2007-02-16 |
| Florida Limited Liability | 2006-03-21 |
Date of last update: 28 Jan 2025
Sources: Florida Department of State
