| Entity Name: | YASH P. SANGWAN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 May 2001 (24 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 15 Jul 2022 (3 years ago) |
| Document Number: | P01000053491 |
| FEI/EIN Number | 593718773 |
| Address: | 1411 SOUTH 14TH ST., STE. C, FERNANDINA BEACH, FL, 32034, US |
| Mail Address: | 1411 SOUTH 14TH ST., STE. C, FERNANDINA BEACH, FL, 32034, US |
| ZIP code: | 32034 |
| County: | Nassau |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396057733 | 2010-07-13 | 2010-07-28 | 1411 S 14TH ST, SUITE C, FERNANDINA BEACH, FL, 320343031, US | 1411 S 14TH ST, STE C, FERNANDINA BEACH, FL, 320343031, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-261-6209 |
| Fax | 9042610732 |
Authorized person
| Name | DR. YASH PAL SANGWAN |
| Role | PRESIDENT |
| Phone | 9042616209 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | ME78773 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208C00000X - Colon & Rectal Surgery Physician |
| License Number | ME78773 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001122600 |
| State | FL |
| Issuer | MEDICARE LEGACY NUMBER |
| Number | E2938A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SANGWAN YASH P | Agent | 8338 Courtyards Lane, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| SANGWAN YASH P | President | 8338 Courtyrds Lane, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| SANGWAN YASH P | Secretary | 8338 Courtyrds Lane, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| SANGWAN YASH P | Treasurer | 8338 Courtyrds Lane, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| SANGWAN YASH P | Director | 8338 Courtyrds Lane, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| SANGWAN NERRA | Manager | 8338 COURTYARDS LANE, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2022-07-15 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-05 | 8338 Courtyards Lane, JACKSONVILLE, FL 32256 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-04-07 | 1411 SOUTH 14TH ST., STE. C, FERNANDINA BEACH, FL 32034 | No data |
| CHANGE OF MAILING ADDRESS | 2004-04-07 | 1411 SOUTH 14TH ST., STE. C, FERNANDINA BEACH, FL 32034 | No data |
| AMENDMENT | 2001-08-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-02 |
| ANNUAL REPORT | 2023-01-23 |
| Amendment | 2022-07-15 |
| ANNUAL REPORT | 2022-03-01 |
| ANNUAL REPORT | 2021-01-26 |
| ANNUAL REPORT | 2020-03-30 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-04-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
