| Entity Name: | DAYTONA PEDIATRICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 28 Mar 2019 (6 years ago) |
| Document Number: | L19000086073 |
| FEI/EIN Number | 83-4301606 |
| Address: | 915 Big Tree Road, South Daytona, FL 32119 |
| Mail Address: | 915 BIG TREE RD, SOUTH DAYTONA, FL 32119 |
| ZIP code: | 32119 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205399060 | 2019-04-09 | 2019-04-09 | 67 COQUINA RIDGE WAY, ORMOND BEACH, FL, 321741812, US | 909 BIG TREE RD, SOUTH DAYTONA, FL, 321192517, US | |||||||||||||||||||||||
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| Phone | +1 386-366-4873 |
| Fax | 3866762555 |
| Phone | +1 386-676-0255 |
Authorized person
| Name | DR. AMAR N SINGH |
| Role | OWNER |
| Phone | 3863664873 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271799900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Webb, Heidi | Agent | 210 S Beach Street Suite 202, Daytona Beach, FL 32114 |
| Name | Role | Address |
|---|---|---|
| SINGH, Sangeeta | Manager | 67 COQUINA RIDGE WAY, ORMOND BEACH 32174 UN |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-21 | Webb, Heidi | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-21 | 210 S Beach Street Suite 202, Daytona Beach, FL 32114 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-29 | 915 Big Tree Road, South Daytona, FL 32119 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-03 | 915 Big Tree Road, South Daytona, FL 32119 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-21 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-02-04 |
| Florida Limited Liability | 2019-03-28 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
