| Entity Name: | FLORIDA DERMATOLOGY PLASTIC SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Aug 2016 (9 years ago) |
| Document Number: | L16000147305 |
| FEI/EIN Number | 813526597 |
| Address: | 1901 S. HARBOR CITY BOULEVARD, SUITE 720, MELBOURNE, FL, 32901, US |
| Mail Address: | 1901 S. HARBOR CITY BOULEVARD, SUITE 720, MELBOURNE, FL, 32901, US |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295278943 | 2016-11-29 | 2020-06-02 | PO BOX 628721, ORLANDO, FL, 328628721, US | 6559 N WICKHAM RD, SUITE 105, MELBOURNE, FL, 329402039, US | |||||||||||||||||||||||||||
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| Phone | +1 321-241-1160 |
| Phone | +1 321-345-0552 |
Authorized person
| Name | ANITA SALUJA |
| Role | MANAGER |
| Phone | 3219173067 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | M82777 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| License Number | ME118444 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| O'BRIEN JAMES M | Agent | 1901 S. HARBOR CITY BOULEVARD, MELBOURNE, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| Novo Rebecca | Asst | 1901 S. HARBOR CITY BOULEVARD, MELBOURNE, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| Saluja Anita | Manager | 1901 S. Harbor City Boulevard, Melbourne, FL, 32901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000037474 | DERMATOLOGY + PLASTIC SURGERY | ACTIVE | 2017-04-07 | 2027-12-31 | No data | 6559 N WICKHAM RD SUITE C105, MELBOURNE, FL, 32940 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-01-12 |
| ANNUAL REPORT | 2019-01-29 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-03-22 |
| Florida Limited Liability | 2016-08-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
