| Entity Name: | DR. CHAUDHRY, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Aug 2018 (6 years ago) |
| Document Number: | L18000200805 |
| FEI/EIN Number | 831679066 |
| Address: | 12977 SOUTHERN BLVD, SUITE 200, LOXAHATCHEE, FL, 33470, US |
| Mail Address: | 12977 Southern Blvd Suite 200: Loxahatchee, SUITE 200, LOXAHATCHEE, FL, 33470, US |
| ZIP code: | 33470 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619458643 | 2018-08-27 | 2018-10-18 | 500 NE SPANISH RIVER BLVD STE 28A, BOCA RATON, FL, 334314517, US | 500 NE SPANISH RIVER BLVD STE 28A, BOCA RATON, FL, 33431, US | |||||||||||||||||||||||
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| Phone | +1 561-855-1999 |
Authorized person
| Name | DR. RABIA QUDDUS CHAUDHRY |
| Role | ALLERGIST & IMMUNOLOGIST |
| Phone | 5618551999 |
Taxonomy
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | 123352 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019792000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHAUDHRY RABIA QDR. | Agent | 12977 Southern Blvd Suite 200: Loxahatchee, LOXAHATCHEE, FL, 33470 |
| Name | Role | Address |
|---|---|---|
| CHAUDHRY RABIA QDR. | Manager | 12977 SOUTHERN BLVD, LOXAHATCHEE, FL, 33470 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000095967 | SOUTH FLORIDA FOOD ALLERGY CENTER | ACTIVE | 2018-08-28 | 2028-12-31 | No data | 12977 SOUTHERN BLVD, 200, LOXAHATCHEE, FL, 33470 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-12 | 12977 SOUTHERN BLVD, SUITE 200, LOXAHATCHEE, FL 33470 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-12 | 12977 SOUTHERN BLVD, SUITE 200, LOXAHATCHEE, FL 33470 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-12 | 12977 Southern Blvd Suite 200: Loxahatchee, FL 33470 SOUTHERN BLVD, SUITE 200, LOXAHATCHEE, FL 33470 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-06-18 |
| Florida Limited Liability | 2018-08-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
