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  5. KASHYAP PATEL MD PA.

KASHYAP PATEL MD PA.

Company Details

Entity Name: KASHYAP PATEL MD PA.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Aug 2004 (21 years ago)
Last Event: ARTICLES OF CORRECTION/NAME CHANGE
Event Date Filed: 02 Sep 2004 (20 years ago)
Document Number: P04000113706
FEI/EIN Number 201443934
Address: 325 Clyde Morris Blvd, ORMOND BEACH, FL, 32174, US
Mail Address: 325 Clyde Morris Blvd, ORMOND BEACH, FL, 32174, US
ZIP code: 32174
County: Volusia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1114037462 2006-08-30 2014-01-14 325 CLYDE MORRIS BLVD STE 340, ORMOND BEACH, FL, 321743199, US 325 CLYDE MORRIS BLVD STE 340, ORMOND BEACH, FL, 321743199, US

Contacts
Phone +1 386-615-8971
Fax 3866779685

Authorized person
Name KASHYAP PATEL
Role PRESIDENT
Phone 3866158971

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME90826
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 270963500
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KASHYAP PATEL MD PA 401K PLAN 2023 201443934 2024-06-27 KASHYAP PATEL MD PA 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2024-06-27
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2022 201443934 2023-06-26 KASHYAP PATEL MD PA 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2023-06-26
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2021 201443934 2022-05-11 KASHYAP PATEL MD PA 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2022-05-11
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2020 201443934 2021-09-01 KASHYAP PATEL MD PA 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2021-09-01
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2019 201443934 2020-07-07 KASHYAP PATEL MD PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2020-07-07
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-07
Name of individual signing KASHYAP PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2018 201443934 2019-04-24 KASHYAP PATEL MD PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2019-04-24
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2017 201443934 2018-05-16 KASHYAP PATEL MD PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2018-05-16
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2016 201443934 2017-06-29 KASHYAP PATEL MD PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2017-06-29
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-29
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2015 201443934 2016-06-21 KASHYAP PATEL MD PA 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2016-06-21
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
KASHYAP PATEL MD PA 401K PLAN 2014 201443934 2015-10-21 KASHYAP PATEL MD PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621498
Sponsor’s telephone number 3866158971
Plan sponsor’s address 325 CLYDE MORRIS BLVD SUITE 340, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2015-10-21
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-21
Name of individual signing TEJAL PATEL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Patel Kashyap Agent 325 Clyde Morris Blvd, ORMOND BEACH, FL, 32174

President

Name Role Address
PATEL KASHYAP M President 325 Clyde Morris Blvd, ORMOND BEACH, FL, 32174

Secretary

Name Role Address
Patel Tejal Secretary 325 Clyde Morris Blvd, ORMOND BEACH, FL, 32174

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G19000057379 A ONE FAMILY PRACTICE EXPIRED 2019-05-13 2024-12-31 No data 325 CLYDE MORRIS BLVD, ORMOND BEACH, FL, 32174
G13000080887 A-ONE FAMILY PRACTICE EXPIRED 2013-08-14 2018-12-31 No data 31 DEEP WOODS WAY, ORMOND BEACH, FL, 32174

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-02-04 Patel, Kashyap No data
REGISTERED AGENT ADDRESS CHANGED 2024-02-04 325 Clyde Morris Blvd, 340, ORMOND BEACH, FL 32174 No data
CHANGE OF PRINCIPAL ADDRESS 2016-04-30 325 Clyde Morris Blvd, 340, ORMOND BEACH, FL 32174 No data
CHANGE OF MAILING ADDRESS 2016-04-30 325 Clyde Morris Blvd, 340, ORMOND BEACH, FL 32174 No data
ARTICLES OF CORRECT-ION/NAME CHANGE 2004-09-02 KASHYAP PATEL MD PA. No data

Documents

Name Date
ANNUAL REPORT 2024-02-04
ANNUAL REPORT 2023-03-18
ANNUAL REPORT 2022-02-20
ANNUAL REPORT 2021-05-03
ANNUAL REPORT 2020-05-05
ANNUAL REPORT 2019-04-06
ANNUAL REPORT 2018-02-24
ANNUAL REPORT 2017-01-28
ANNUAL REPORT 2016-04-30
ANNUAL REPORT 2015-03-28

Related by officers

PATEL KASHYAP M

BAPS MEDICAL SERVICES, INC.

Patel Tejal

LINCOLN HOSPITALITY MANAGEMENT, LLC 325 CLYDE MORRIS, LLC TRADEWINDS LODGING, LLC TEJALHENNA LLC ATLANTIC BEACH LODGING, LLC ATLANTIC BEACH MANAGEMENT, LLC 1 STOP CURE, PLLC JAVANI MED SPAS LLC WPVA, INC. SOUTHPOINT HOSPITALITY LLC

Related by address

325 Clyde Morris Blvd, ORMOND BEACH, FL, 32174, US

VICTORINA'S DIABETES ENDOCRINOLOGY AND METABOLISM, INC.,

325 Clyde Morris Blvd, ORMOND BEACH, FL, 32174, US

VICTORINA'S DIABETES ENDOCRINOLOGY AND METABOLISM, INC.,

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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