| Entity Name: | PAYAL JHAWAR MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Apr 2020 (5 years ago) |
| Document Number: | L20000101794 |
| FEI/EIN Number | 85-0739231 |
| Address: | 2810 Manatee Ave E, BRADENTON, FL, 34208, US |
| Mail Address: | 366 CHANTILLY TRAIL, BRADENTON, FL, 34212, US |
| ZIP code: | 34208 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609545326 | 2021-09-07 | 2021-09-07 | 366 CHANTILLY TRL, BRADENTON, FL, 342125020, US | 2810 MANATEE AVE E, BRADENTON, FL, 342081828, US | |||||||||||||||||
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| Phone | +1 860-519-2376 |
| Phone | +1 941-777-5118 |
| Fax | 4692429547 |
Authorized person
| Name | DR. PAYAL JHAWAR |
| Role | FOUNDER AND CEO |
| Phone | 8605192376 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JHAWAR PAYAL | Agent | 366 CHANTILLY TRAIL, BRADENTON, FL, 34212 |
| Name | Role | Address |
|---|---|---|
| JHAWAR PAYAL | Manager | 366 CHANTILLY TRAIL, BRADENTON, FL, 34212 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000081572 | REVIVE MD DIRECT PRIMARY CARE | ACTIVE | 2021-06-18 | 2026-12-31 | No data | 2810 MANATEE AVENUE E, BRADENTON, FL, 34208 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-06-16 | 2810 Manatee Ave E, BRADENTON, FL 34208 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-02-04 |
| Florida Limited Liability | 2020-04-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
