| Entity Name: | CINDIE RAYBON, MD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Mar 2018 (7 years ago) |
| Document Number: | L18000059413 |
| FEI/EIN Number | 824817439 |
| Address: | 700 Zeagler Drive,, PALATKA, FL, 32177, US |
| Mail Address: | 700 ZEAGLER DRIVE, PALATKA, FL, 32177, US |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043708217 | 2018-04-24 | 2018-04-24 | 109 SUNSET PT, PALATKA, FL, 321779048, US | 700 ZEAGLER DR STE 7, PALATKA, FL, 321773826, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 352-212-1767 |
| Fax | 3864872113 |
| Phone | +1 386-385-8137 |
Authorized person
| Name | CINDIE RAYBON |
| Role | OWNER |
| Phone | 3522121796 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME60390 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1548353204 |
| State | FL |
| Issuer | MEDICAID |
| Number | 374809000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RAYBON ALAN R | Agent | 700 Zeagler Drive,, PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| RAYBON CINDIE L | Manager | 700 Zeagler Drive,, PALATKA, FL, 32177 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000042963 | RAYBON PEDIATRICS | ACTIVE | 2018-04-03 | 2028-12-31 | No data | 700 ZEAGLER DRIVE, STE 7, PALATKA, FL, 32177 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-04 | 700 Zeagler Drive,, Suite 7, PALATKA, FL 32177 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-14 | 700 Zeagler Drive,, Suite 7, PALATKA, FL 32177 | No data |
| CHANGE OF MAILING ADDRESS | 2021-07-27 | 700 Zeagler Drive,, Suite 7, PALATKA, FL 32177 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-03-09 |
| ANNUAL REPORT | 2019-03-18 |
| Florida Limited Liability | 2018-03-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
