| Entity Name: | SRINIVAS DONTINENI, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Jul 2008 (17 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 31 Oct 2018 (6 years ago) |
| Document Number: | P08000068688 |
| FEI/EIN Number | 900403142 |
| Address: | 2428 Clearlake Blvd, BLDG K, Cocoa, FL, 32922, US |
| Mail Address: | PO Box 560059, Rockledge, FL, 32956, US |
| ZIP code: | 32922 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639323041 | 2008-11-12 | 2020-08-02 | PO BOX 560059, ROCKLEDGE, FL, 329560059, US | 2800 AURORA RD STE F, MELBOURNE, FL, 329352015, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 321-751-9506 |
| Fax | 3217519505 |
| Phone | +1 321-368-3862 |
| Fax | 3212088717 |
Authorized person
| Name | DR. SRINIVAS RAO DONTINENI |
| Role | INTERNAL MEDICINE PHYSICIAN |
| Phone | 3217519506 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | BM919A |
| State | FL |
| Issuer | MEDICAID |
| Number | 004793700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DONTINENI SRINIVAS R | Agent | 3358 Lamanga Dr, Melbourne, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| DONTINENI SRINIVAS R | Director | 3358 Lamanga Dr, Melbourne, FL, 32940 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000026973 | BREVARD HOSPITALIST ASSOCIATES | EXPIRED | 2010-03-24 | 2015-12-31 | No data | 6550 N. WICKHAM RD, SUITE #2, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-20 | 2428 Clearlake Blvd, BLDG K, Cocoa, FL 32922 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-10-31 | 3358 Lamanga Dr, Melbourne, FL 32940 | No data |
| REINSTATEMENT | 2018-10-31 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-10-31 | 2428 Clearlake Blvd, BLDG K, Cocoa, FL 32922 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-13 | DONTINENI, SRINIVAS R | No data |
| REINSTATEMENT | 2016-10-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| AMENDMENT | 2008-12-11 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-27 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-07-21 |
| ANNUAL REPORT | 2019-04-30 |
| REINSTATEMENT | 2018-10-31 |
| REINSTATEMENT | 2016-10-13 |
| ANNUAL REPORT | 2015-04-20 |
| ANNUAL REPORT | 2014-03-05 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
