| Entity Name: | SUN STATE DERMATOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Apr 2023 (2 years ago) |
| Document Number: | L23000207795 |
| FEI/EIN Number | 92-3790061 |
| Address: | 430 Lake Howell Road, Maitland, FL 32751 |
| Mail Address: | 430 Lake Howell Road, Maitland, FL 32751 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093496432 | 2023-07-28 | 2024-01-06 | 430 LAKE HOWELL RD, MAITLAND, FL, 327515907, US | 430 LAKE HOWELL RD, MAITLAND, FL, 327515907, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 407-636-3113 |
| Fax | 4076363133 |
Authorized person
| Name | NATHOO K RAJIV |
| Role | PRACTICE OWNER |
| Phone | 4076363113 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Nathoo, Rajvee | Agent | 430 Lake Howell Road, Maitland, FL 32751 |
| Name | Role | Address |
|---|---|---|
| NATHOO, RAJIV K | Manager | 430 Lake Howell Road, Maitland, FL 32751 |
| Nathoo, RAJVEE | Manager | 430 Lake Howell Road, Maitland, FL 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-01-23 | 430 Lake Howell Road, Maitland, FL 32751 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-23 | Nathoo, Rajvee | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-23 | 430 Lake Howell Road, Maitland, FL 32751 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-12-14 | 430 Lake Howell Road, Maitland, FL 32751 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| Florida Limited Liability | 2023-04-26 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
