| Entity Name: | COUNTRYSIDE PEDIATRIC CARE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 05 May 2014 (11 years ago) |
| Document Number: | P14000039612 |
| FEI/EIN Number | 46-5598598 |
| Address: | 2531 Landmark Dr., STE 103, CLEARWATER, FL 33761 |
| Mail Address: | 2531 Landmark Dr., STE 103, CLEARWATER, FL 33761 |
| ZIP code: | 33761 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518370345 | 2014-06-10 | 2024-07-11 | 2531 LANDMARK DR STE 103, CLEARWATER, FL, 337613928, US | 2531 LANDMARK DR STE 103, CLEARWATER, FL, 337613928, US | |||||||||||||||||||
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| Phone | +1 727-599-0893 |
| Fax | 7276742965 |
Authorized person
| Name | MONICA KHARBANDA |
| Role | PRESIDENT |
| Phone | 7275990893 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME 92529 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SINGH, GUNJAN | Agent | 305 Signature Terrace, SAFETY HARBOR, FL 34695 |
| Name | Role | Address |
|---|---|---|
| KHARBANDA, MONICA | Director | 305 Signature Terrace, SAFETY HARBOR, FL 34695 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-10-21 | 2531 Landmark Dr., STE 103, CLEARWATER, FL 33761 | No data |
| CHANGE OF MAILING ADDRESS | 2022-10-21 | 2531 Landmark Dr., STE 103, CLEARWATER, FL 33761 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-02-14 | 305 Signature Terrace, SAFETY HARBOR, FL 34695 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-05-01 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
