| Entity Name: | KAMLESH P. PANDYA, MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Sep 2015 (9 years ago) |
| Date of dissolution: | 15 Jun 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 15 Jun 2020 (5 years ago) |
| Document Number: | L15000151798 |
| FEI/EIN Number | 81-1029227 |
| Address: | 2100 Nebraska Ave Suite 202, Fort Pierce, FL, 34950, US |
| Mail Address: | 2100 Nebraska Ave Suite 202, Fort Pierce, FL, 34950, US |
| ZIP code: | 34950 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659738789 | 2016-01-20 | 2017-01-05 | 8980 S US HIGHWAY 1, SUITE 101, PORT ST LUCIE, FL, 349523482, US | 8980 S US HIGHWAY 1, SUITE 101, PORT ST LUCIE, FL, 349523482, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 772-807-6500 |
| Fax | 7728076501 |
Authorized person
| Name | DR. KAMLESH P PANDYA |
| Role | OWNER |
| Phone | 7728076500 |
Taxonomy
| Taxonomy Code | 207RC0200X - Critical Care Medicine (Internal Medicine) Physician |
| License Number | FL ME0059031 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| License Number | FL ME0059031 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207RS0012X - Sleep Medicine (Internal Medicine) Physician |
| License Number | FL ME0059031 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051911100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PANDYA KAMLESH P | Agent | 2100 Nebraska Ave Suite 202, Fort Pierce, FL, 34950 |
| Name | Role | Address |
|---|---|---|
| PANDYA KAMLESH P | Manager | 2100 Nebraska Ave Suite 202, Fort Pierce, FL, 34950 |
| Name | Role | Address |
|---|---|---|
| Pandya Jagruti P | Chief Executive Officer | 2100 Nebraska Ave Suite 202, Fort Pierce, FL, 34950 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-06-15 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-04 | 2100 Nebraska Ave Suite 202, Fort Pierce, FL 34950 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-04 | 2100 Nebraska Ave Suite 202, Fort Pierce, FL 34950 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-04 | 2100 Nebraska Ave Suite 202, Fort Pierce, FL 34950 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-06-15 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-09 |
| ANNUAL REPORT | 2017-04-04 |
| ANNUAL REPORT | 2016-04-06 |
| Florida Limited Liability | 2015-09-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
