| Entity Name: | DIVANI DERMATOLOGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 31 Aug 2018 (6 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 07 Aug 2020 (4 years ago) |
| Document Number: | L18000209169 |
| FEI/EIN Number | 83-1890213 |
| Address: | 8745 US HWY 1, SEBASTIAN, FL 32958 |
| Mail Address: | 8745 US HWY 1, SEBASTIAN, FL 32958 |
| ZIP code: | 32958 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255986113 | 2019-08-07 | 2020-04-15 | 8745 N US HIGHWAY 1, SEBASTIAN, FL, 329587524, US | 8745 N US HIGHWAY 1, SEBASTIAN, FL, 329587524, US | |||||||||||||||
|
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| Phone | +1 772-217-5362 |
| Fax | 7722187267 |
Authorized person
| Name | ANAND HARYANI |
| Role | MD/OWNER |
| Phone | 7722175362 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DIVANI DERMATOLOGY 401(K) PLAN | 2023 | 831890213 | 2024-05-22 | DIVANI DERMATOLOGY, LLC | 21 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-22 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7722175362 |
| Plan sponsor’s address | 8745 US HWY 1, SEBASTIAN, FL, 32958 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-27 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7722175362 |
| Plan sponsor’s address | 8745 N US HWY 1, SEBASTIAN, FL, 32958 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2022-05-23 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SADHWANI, DIVYA | Agent | 8745 US HWY 1, SEBASTIAN, FL 32958 |
| Name | Role | Address |
|---|---|---|
| HARYANI, ANAND | Manager | 8745 US HWY 1, SEBASTIAN, FL 32958 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000088999 | DIVANI DERMATOLOGY LLC | ACTIVE | 2022-07-28 | 2027-12-31 | No data | 8745 N. US HWY 1, SEBASTIAN, FL, 32958 |
| G22000068389 | VERO BEACH - ICONIC DERMATOLOGY | ACTIVE | 2022-06-03 | 2027-12-31 | No data | 4800 20TH STREET, VERO BEACH, FL, 32966 |
| G21000144223 | MELBOURNE - ICONIC DERMATOLOGY | ACTIVE | 2021-10-27 | 2026-12-31 | No data | 2571 EAU GALLIE BLVD,SUITE 2, MELBOURNE, FL, 32935 |
| G21000144222 | SEBASTIAN - ICONIC DERMATOLOGY | ACTIVE | 2021-10-27 | 2026-12-31 | No data | 8745 N US HWY 1, SEBASTIAN, FL, 32958 |
| G21000112038 | ICONIC DERMATOLOGY AND COSMETIC SURGERY | ACTIVE | 2021-08-30 | 2026-12-31 | No data | 8745 N US HWY 1, SEBASTIAN, FL, 32958 |
| G19000120927 | HARYANI DERMATOLOGY AND AESTHETICS | EXPIRED | 2019-11-11 | 2024-12-31 | No data | 8745 N US HWY 1, SEBASTIAN, FL, 32958 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2020-08-07 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-19 | 8745 US HWY 1, SEBASTIAN, FL 32958 | No data |
| LC AMENDMENT | 2019-11-07 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-11-02 | 8745 US HWY 1, SEBASTIAN, FL 32958 | No data |
| CHANGE OF MAILING ADDRESS | 2019-11-02 | 8745 US HWY 1, SEBASTIAN, FL 32958 | No data |
| REINSTATEMENT | 2019-10-09 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-09 | SADHWANI, DIVYA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-13 |
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-01-12 |
| LC Amendment | 2020-08-07 |
| ANNUAL REPORT | 2020-03-19 |
| LC Amendment | 2019-11-07 |
| REINSTATEMENT | 2019-10-09 |
| Florida Limited Liability | 2018-08-31 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
