| Entity Name: | SASHA M DAVIDSON LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Nov 2017 (7 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Aug 2018 (6 years ago) |
| Document Number: | L17000226566 |
| FEI/EIN Number | 823268664 |
| Address: | 401 E LAS OLAS BLVD, SUITE 130-415, FORT LAUDERDALE, FL, 33301, US |
| Mail Address: | 401 E LAS OLAS BLVD, SUITE 130-415, FORT LAUDERDALE, FL, 33301, US |
| ZIP code: | 33301 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477022663 | 2018-11-16 | 2018-11-20 | 401 E LAS OLAS BLVD STE 130-415, FORT LAUDERDALE, FL, 333012210, US | 2151 E COMMERCIAL BLVD STE 202, FORT LAUDERDALE, FL, 333083807, US | |||||||||||||||||||||||
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| Phone | +1 202-276-8068 |
| Fax | 5802791132 |
| Phone | +1 954-900-6228 |
Authorized person
| Name | SASHA M DAVIDSON |
| Role | OWNER/MEDICAL DIRECTOR |
| Phone | 2022768068 |
Taxonomy
| Taxonomy Code | 207VM0101X - Maternal & Fetal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017611500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DAVIDSON SASHA | Agent | 401 E LAS OLAS BLVD, FORT LAUDERDALE, FL, 33301 |
| Name | Role | Address |
|---|---|---|
| DAVIDSON SASHA | Manager | 401 E LAS OLAS BLVD, FORT LAUDERDALE, FL, 33301 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000123100 | SIGNATURE PERINATAL CENTER | ACTIVE | 2018-11-16 | 2028-12-31 | No data | 401 E LAS OLAS BLVD, SUITE 130-415, FORT LAUDERDALE, FL, 33301 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-08 | 401 E LAS OLAS BLVD, SUITE 130-415, FORT LAUDERDALE, FL 33301 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-08 | 401 E LAS OLAS BLVD, SUITE 130-415, FORT LAUDERDALE, FL 33301 | No data |
| LC STMNT OF RA/RO CHG | 2018-08-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-08-22 | DAVIDSON, SASHA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-08-22 | 401 E LAS OLAS BLVD, SUITE 130-145, FORT LAUDERDALE, FL 33301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-02-19 |
| CORLCRACHG | 2018-08-22 |
| ANNUAL REPORT | 2018-07-30 |
| Florida Limited Liability | 2017-11-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
