| Entity Name: | SITA DUGGIRALA MD., PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Nov 2012 (12 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 08 Nov 2016 (8 years ago) |
| Document Number: | P12000097053 |
| FEI/EIN Number | 46-1449093 |
| Address: | 7730 W. Waters Ave, TAMPA, FL, 33615, US |
| Mail Address: | 7730 W. Waters Ave, TAMPA, FL, 33615, US |
| ZIP code: | 33615 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922441344 | 2013-04-16 | 2013-04-16 | 7730 W WATERS AVE, TAMPA, FL, 336151813, US | 7730 W WATERS AVE, TAMPA, FL, 336151813, US | |||||||||||||||||||||||||||||||
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| Phone | +1 813-887-1010 |
| Fax | 8138871021 |
Authorized person
| Name | SITA LAKSHMI DUGGIRALA |
| Role | OWNER |
| Phone | 8138871010 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME96395 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 276288900 |
| State | FL |
| Issuer | CAQH |
| Number | 11638012 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DUGGIRALA SITA | Agent | 7730 W. Waters Avenue, Tampa, FL, 35615 |
| Name | Role | Address |
|---|---|---|
| DUGGIRALA SITA | President | 12137 Clear Harbor Dr., Tampa, FL, 33626 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000113334 | WATERS PEDIATRIC CENTER | ACTIVE | 2012-11-27 | 2027-12-31 | No data | 7730 W WATERS AVE, TAMPA, FL, 33615 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-20 | 7730 W. Waters Avenue, Tampa, FL 35615 | No data |
| REINSTATEMENT | 2016-11-08 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-11-08 | DUGGIRALA, SITA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-01-29 | 7730 W. Waters Ave, TAMPA, FL 33615 | No data |
| CHANGE OF MAILING ADDRESS | 2015-01-29 | 7730 W. Waters Ave, TAMPA, FL 33615 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-14 |
| ANNUAL REPORT | 2024-07-23 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-05-20 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-09 |
| REINSTATEMENT | 2016-11-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
