| Entity Name: | DOC AESTHETICS.LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Aug 2023 (a year ago) |
| Document Number: | L23000372956 |
| FEI/EIN Number | 93-2822048 |
| Address: | 2215 NEBRASKA AVENUE, 2B, FORT PIERCE, FL 34950 |
| Mail Address: | 2215 NEBRASKA AVENUE, 2B, FORT PIERCE, FL 34950 |
| ZIP code: | 34950 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275354128 | 2024-10-23 | 2024-10-23 | 2215 NEBRASKA AVE, STE 2B, FORT PIERCE, FL, 34950, US | 2215 NEBRASKA AVE, STE 2B, FORT PIERCE, FL, 349504867, US | |||||||||||||||||||
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| Phone | +1 772-302-3767 |
Authorized person
| Name | CHINTAN SHAH |
| Role | PROVIDER |
| Phone | 7723023767 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006739300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHAH, ZEAL C | Agent | 8113 KIAWAH TRCE, PORT ST LUCIE, FL 34986 |
| Name | Role | Address |
|---|---|---|
| SHAH, CHINTAN | Manager | 8113 KIAWAH TRCE, PORT ST LUCIE, FL 34986 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| Florida Limited Liability | 2023-08-08 |
Date of last update: 09 Jan 2025
Sources: Florida Department of State
