| Entity Name: | DEVYANI BELSARE, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Feb 2009 (16 years ago) |
| Document Number: | L09000019094 |
| FEI/EIN Number | 264347659 |
| Address: | 761 CIARA CREEK CV, LONGWOOD, FL, 32750, US |
| Mail Address: | 761 CIARA CREEK CV, LONGWOOD, FL, 32750, US |
| ZIP code: | 32750 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740592377 | 2010-07-12 | 2024-10-08 | 761 CIARA CREEK CV, LONGWOOD, FL, 327504659, US | 761 CIARA CREEK CV, LONGWOOD, FL, 327504659, US | |||||||||||||||||||||||||
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| Phone | +1 407-557-2165 |
| Fax | 4075506409 |
Authorized person
| Name | DEVYANI BELSARE |
| Role | MANAGING MEMBER |
| Phone | 4075572165 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME 100607 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000602500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BELSARE DEVYANI | Agent | 251 MAITLAND AVENUE, SUITE #104, ALTAMONTE SPRINGS, FL, 32701 |
| Name | Role | Address |
|---|---|---|
| BELSARE DEVYANI | Manager | 251 MAITLAND AVENUE SUITE 104, ALTAMONTE SPRINGS, FL, 32701 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000038750 | ORANGE PEDIATRICS | ACTIVE | 2010-05-03 | 2025-12-31 | No data | 761 CIARA CREEK COVE, LONGWOOD, FL, 32750 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-17 | 761 CIARA CREEK CV, LONGWOOD, FL 32750 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-17 | 761 CIARA CREEK CV, LONGWOOD, FL 32750 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-05-04 | 251 MAITLAND AVENUE, SUITE #104, ALTAMONTE SPRINGS, FL 32701 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-03-15 |
| ANNUAL REPORT | 2017-02-13 |
| ANNUAL REPORT | 2016-03-21 |
| ANNUAL REPORT | 2015-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
